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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376614286
Report Date: 09/30/2019
Date Signed: 09/30/2019 10:37:46 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:BERTHIAUME, JENNIPHAR FAMILY CHILD CAREFACILITY NUMBER:
376614286
ADMINISTRATOR:BERTHIAUME, JENNIPHARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 847-3401
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:14CENSUS: 3DATE:
09/30/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jenniphar Berthiaume TIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management inspection to correct the prior 09/27/2019 report. LPA spoke with Licensee Berthiaume and was granted facility entry. Licensee was advised of this visit’s purpose.

There were three (3) daycare children supervised by the Licensee and one (1) helper.

The LIC 9099 report, dated 09/27/2019, contained grammatical errors. The prior and corrected reports were reviewed by Licensee and LPA. The Licensee signed the corrected report and was provided with a copy of the signed corrected report.

An exit interview was conducted with Licensee. Licensee/Appeal Rights (LIC 9098 01/16) along with a copy of this report was provided to Licensee and their signature on this form confirms receipt of these rights.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2019
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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