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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376610537
Report Date: 11/10/2021
Date Signed: 12/21/2021 09:31:18 AM

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:BEEMON, LATASHA & JOHNSON, SAMUEL FCCFACILITY NUMBER:
376610537
ADMINISTRATOR:BEEMON, LATASHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 264-1149
CITY:SAN DIEGOSTATE: CAZIP CODE:
92113
CAPACITY:14CENSUS: 9DATE:
11/10/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Latasha Beemon TIME COMPLETED:
05:00 PM
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On 11/10/21 at 3:10 p.m., Licensing Program Analyst (LPA) Casey Gulley arrived to conduct an unannounced inspection for the purpose of interviewing children, staff, and daycare parents. Two (2) staff and nine (9) children were present at the time of the inspection.

No deficiencies cited. Licensee was provided Appeal Rights (LIC9058 01/16) and their signature on this form acknowledges receipt of these rights. LPA provided Notice of Site Visit (LIC9213) and observed that was posted during the inspection. An exit interview was conducted with licensee, Latasha Beemon.


This is an amended version of the original report created on 11/10/21.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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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