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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000610
Report Date: 06/01/2022
Date Signed: 06/01/2022 03:16:33 PM


Document Has Been Signed on 06/01/2022 03:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:UNIVERSITY CITY UNITED CHURCH NURSERY SCHOOLFACILITY NUMBER:
372000610
ADMINISTRATOR:JESSICA FRAZIERFACILITY TYPE:
850
ADDRESS:2877 GOVERNOR DRIVETELEPHONE:
(858) 455-0336
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY:45CENSUS: 23DATE:
06/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Jessica FrazierTIME COMPLETED:
11:35 AM
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On 6/1/2022 at approximately 9:10 AM, Licensing Program Analyst (LPA), Daniel Pena, made an unannounced visit to follow up on a self-reported incident that occurred on 4/21/22, where it was alleged that Staff #1 violated the personal rights of a child (Child #1). LPA was met at the entrance by Director, Jessica Frazier. After identifying himself, explaining the purpose of the visit, LPA was granted entry into the facility. Census on the day of the visit was 23 children. LPA observed that the staff to child ratio was appropriate.

LPA conducted a walk through of the center. LPA also interviewed children, staff and reviewed records.

Based on the information obtained during interviews and review of documentation, there is no evidence the aforementioned allegation occurred.

No citations were issued during the visit.

Notice of Site Visit was given and will remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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