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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376600804
Report Date:
02/18/2020
Date Signed:
02/18/2020 01:28:33 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:
MY ROOM TO GROW PRESCHOOL
FACILITY NUMBER:
376600804
ADMINISTRATOR:
MARINA SRAGOVICZ
FACILITY TYPE:
850
ADDRESS:
13613 CYNTHIA LANE
TELEPHONE:
(858) 748-8012
CITY:
POWAY
STATE:
CA
ZIP CODE:
92064
CAPACITY:
94
CENSUS:
DATE:
02/18/2020
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:20 PM
MET WITH:
TIME COMPLETED:
01:28 PM
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On 2/18/20 at 1:20 PM Licensing Program Analyst Michael Morales-DeSilvestore was at the facility to obtain a signature on an amended report.
SUPERVISOR'S NAME:
Tashima Daniel
TELEPHONE:
(619) 767-2242
LICENSING EVALUATOR NAME:
Michael Morales-DeSilvestore
TELEPHONE:
(619) 767-2208
LICENSING EVALUATOR SIGNATURE:
DATE:
02/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/18/2020
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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