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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372006237
Report Date: 11/10/2022
Date Signed: 11/10/2022 01:37:35 PM


Document Has Been Signed on 11/10/2022 01:37 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:GRACE LUTHERAN PRESCHOOLFACILITY NUMBER:
372006237
ADMINISTRATOR:BRE MANATAFACILITY TYPE:
850
ADDRESS:643 W. 13TH AVETELEPHONE:
(760) 747-3029
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:155CENSUS: 40DATE:
11/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:24 PM
MET WITH:Darlene Beebe, DirectorTIME COMPLETED:
01:45 PM
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On November 10, 2022 at 1: 20 PM, LPA CIndy Hamilton made an unannounced Case Management visit at Grace Lutheran Preschool to deliver an amended LIC 9099D for a visit conducted on 07/08/22 due to a deficiency amendment from Type A to Type B. LPA met with Director Darlene Beebe .

An exit interview was conducted, and a copy of this report and amended LIC 9099D was provided to the Director. A notice of site visit was also provided and Director reminded notice must be posted for 30 consecutive days.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Cindy HamiltonTELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2022
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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