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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700719
Report Date: 11/03/2022
Date Signed: 11/03/2022 12:54:31 PM


Document Has Been Signed on 11/03/2022 12:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:VIP VILLAGE STATE PRESCHOOL AT NICOLOFF ELEMENTARYFACILITY NUMBER:
376700719
ADMINISTRATOR:EVELIN MEDINAFACILITY TYPE:
850
ADDRESS:1777 HOWARD AVENUETELEPHONE:
(619) 628-8690
CITY:SAN YSIDROSTATE: CAZIP CODE:
92173
CAPACITY:48CENSUS: 0DATE:
11/03/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Stephanie Allsopp, Personnel SupervisorTIME COMPLETED:
01:10 PM
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On 11/03/2022 at 12:00 pm, Licensing Program Analyst (LPA) Michelle Hood arrived at the Human Resources Department at 601 Elm Ave. H, Imperial Beach, CA 91932. LPA met with Stephanie Allsopp. LPA reviewed the staff files.

An exit interview was conducted with Stephanie Allsopp.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022
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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