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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700698
Report Date: 10/26/2021
Date Signed: 10/26/2021 11:02:22 AM

Document Has Been Signed on 10/26/2021 11:02 AM - It Cannot Be Edited

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:NORTH COAST CHURCH PRESCHOOLFACILITY NUMBER:
376700698
ADMINISTRATOR:MARCIA BOECHEFACILITY TYPE:
850
ADDRESS:2405 NORTH SANTA FE AVENUETELEPHONE:
(760) 330-9200
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 165TOTAL ENROLLED CHILDREN: 145CENSUS: 77DATE:
10/26/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Stephanie Taupule/Adminstrative AssistantTIME COMPLETED:
11:10 AM
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Licensing Program Analysts (LPAs) James Wilkerson and Joanne Domingo arrived at this facility to follow-up on an Unusual Incident Report (UIR) Upon meeting with Stephanie Taupule, Administrative Assistant it was discovered that LPA Jeanette Sanchez had previously followed up on this incident with a visit conducted on 10/06/21. The follow-up had already been competed and a technical advisory notice was provided on 10/06/21.

An exit interview was conducted, a Notice of Site Visit posted and a copy of this report was provided to Ms. Taupule on this date..
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2021
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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