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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600869
Report Date: 10/08/2019
Date Signed: 10/08/2019 03:10:52 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:CHARLEY BROWN CHILDREN'S CENTER-INFANTFACILITY NUMBER:
376600869
ADMINISTRATOR:ELIZABETH CORTESEFACILITY TYPE:
830
ADDRESS:5921 JACKSON DRIVETELEPHONE:
(619) 463-5126
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:22CENSUS: 16DATE:
10/08/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Cassidie MacDonaldTIME COMPLETED:
03:25 PM
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Licensing Program Analysts (LPAs) Vicky Williamson and Michelle Palacio conducted a case management inspection. LPA Williamson met with Stephanie Marroquin, Administrative Supervisor. There were 16 infants present with 5 staff members. Director, Elizabeth Cortese requested a visit to the facility to verify the proper positioning of a diaper changing table in classroom #2. Director was not present during time of inspection. LPA and Stephanie Marroquin discussed options for placement of the diaper changing table per Title 22 regulation. Director will contact LPA when changes have been completed.

No deficiencies cited during today's inspection. Stephanie Marroquin, Administrative Supervisor had to leave the facility during the inspection. LPA reviewed this report with Assistant Director, Cassidie MacDonald and a exit interview was conducted. Assistant Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Licensee post Notice of Site Visit.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019
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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