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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700650
Report Date: 01/30/2020
Date Signed: 01/30/2020 07:45:47 AM

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 - FALLBROOK HEAD START - INFANTFACILITY NUMBER:
376700650
ADMINISTRATOR:M'LINDA ROSOLFACILITY TYPE:
830
ADDRESS:405 WEST FALLBROOK STREETTELEPHONE:
(760) 723-4189
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY:12CENSUS: 1DATE:
01/30/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
06:30 AM
MET WITH:Vanessa WoodsTIME COMPLETED:
07:55 AM
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Licensing Program Analyst (LPA) James Wilkerson arrived at this facility to provide the facility with an amended report from an original report dated 05/02/19. LPA met with Director, Vanessa Wood and discussed the amendment.

An exit interview was conducted, appeal rights discussed and provided along with a copy of this report on this date.

A copy of this report must be made available to the public for three years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020
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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