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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700573
Report Date: 11/15/2019
Date Signed: 11/15/2019 11:29:29 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:LISA'S LIL TIKESFACILITY NUMBER:
376700573
ADMINISTRATOR:DANIELS, LISAFACILITY TYPE:
850
ADDRESS:4351 PARKS AVENUETELEPHONE:
(619) 460-6432
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY:50CENSUS: 36DATE:
11/15/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Gini Andrade, Facility RepresentativeTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA), Marie Hernandez conducted the unannounced inspection for records review. On 11/07/2019, LPA conducted a required inspection, but due to time constraints LPA was unable to complete the records review of staff and the children. LPA met with the Facility Representative, Gini Andrade. Present are twenty children with six staff, and sixteen children with two staff on a field trip today.

No deficiency cited today. An exit interview was conducted and a copy of the report, and the Notice of Site Visit was provided to the Representative. LPA observed the Representative post the Notice of Site Visit in a prominent place. The Representative states it is understood that this notice must be posted for 30 days.
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
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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