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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105059
Report Date: 06/28/2021
Date Signed: 06/28/2021 05:17:03 PM

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:ELM PARK PRESCHOOL ACADEMYFACILITY NUMBER:
376105059
ADMINISTRATOR:DENISE BACOYFACILITY TYPE:
850
ADDRESS:13501 COMMUNITY ROADTELEPHONE:
(619) 888-4485
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:49CENSUS: 0DATE:
06/28/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Anthony Bacoy and Denise BacoyTIME COMPLETED:
05:20 PM
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On 06/28/2021 at 4:00pm, Licensing Program Analyst (LPA) Selina Siao met with CEO Anthony Bacoy and Director Denise Bacoy via Zoom. The purpose of today's meeting is to review the two pages LIC184 together and obtain clarifications.

LPA Selina Siao reviewed entire application and observed that the following areas needed updating/correcting: application LIC200A, LIC308, LIC401, updated LIC500, LIC610, Articles of Incorporation, Copies of documents needed for Director Denise Bacoy, parent handbook and admission agreement information that needs to be updated. LPA discussed all areas in detail with facility representatives and the required documents will be submit to Analyst no later than 7/25/2021. Once all requirements are submitted from applicant and the fire department, a pre-licensing inspection will be scheduled.

Items also discussed included Incidental Medical Services.

A copy of this report was reviewed and will be e-mailed to facility representatives. LPA advised that a response to the email confirming receipt is to be received within twenty-four hours. This will act as their signature on today’s report.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021
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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