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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700061
Report Date: 09/29/2021
Date Signed: 09/29/2021 12:51:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MAAC PROJECT HEAD START NORTH COASTFACILITY NUMBER:
376700061
ADMINISTRATOR:TRACEY ASTORGAFACILITY TYPE:
850
ADDRESS:1501 KELLY STREETTELEPHONE:
(760) 966-7135
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:60CENSUS: 14DATE:
09/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH: Director Patricia VillicanaTIME COMPLETED:
01:24 PM
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Licensing Program Analyst (LPA) Otsanya Cameron arrived at the facility; for the purpose of conducting a case management visit to deliver an amended report previously delivered on 9/24/21. LPA met with Director and a census was taken.

LPA Cameron explained and reviewed the amended report with Director Patricia Villicana

An exit interview was held with Patricia Villicana A Notice of Site visit was issued, along with a copy of this report and the amended complaint report. No deficiencies cited at this time.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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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