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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600851
Report Date: 11/17/2022
Date Signed: 11/17/2022 04:36:38 PM


Document Has Been Signed on 11/17/2022 04:36 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:SAY- MARVIN EXTENDED DAY PROGRAMFACILITY NUMBER:
376600851
ADMINISTRATOR:SARANN SOKFACILITY TYPE:
840
ADDRESS:5720 BRUNSWICK AVENUETELEPHONE:
(858) 212-4703
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:112CENSUS: 38DATE:
11/17/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:08 PM
MET WITH:Sarann SokTIME COMPLETED:
04:40 PM
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ON 11/17/22, Licensing Program Analyst (LPA), Tyra Block, conducted an unannounced Plan of Correction visit to verify deficiency cited during visit on 11/1/22, has been cleared. Present were 6 staff and 38 children. Facility was within ratio and capacity. Iriz Stone, Senior Program Director, submitted by email the written plan of compliance prior to POC due date. POC was cleared and POC letter provided to Sarann Sok.

A Notice of Site Visit was provided and must be posted for 30 days.

An exit interview was conducted with facility representative, Sarann Sok.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra BlockTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022
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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