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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600804
Report Date: 02/27/2020
Date Signed: 02/27/2020 04:58:46 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 PRESCHOOLFACILITY NUMBER:
376600804
ADMINISTRATOR:MARINA SRAGOVICZFACILITY TYPE:
850
ADDRESS:13613 CYNTHIA LANETELEPHONE:
(858) 748-8012
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:94CENSUS: 50DATE:
02/27/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:50 PM
MET WITH:Emily Johnson, TeacherTIME COMPLETED:
05:10 PM
NARRATIVE
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Licensing Program Analyst, Joelle Redding, made an unannounced visit to deliver an amended LIC 9099. The original, dated 2/3/20, inaccurately reflected the findings as "Substantiated" in the marked box under the narrative. LPA amended the findings to reflect the correct finding as "Unsubstantiated."
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
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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