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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376701077
Report Date:
10/06/2023
Date Signed:
10/06/2023 09:42:52 AM
Document Has Been Signed on
10/06/2023 09:42 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
,
7575 METROPOLITAN DR STE 110
SAN DIEGO
,
CA
92108
FACILITY NAME:
EASTER SEALS CHILD DEVELOPMENT CENTER
FACILITY NUMBER:
376701077
ADMINISTRATOR:
LLUVIA SICAIROS
FACILITY TYPE:
850
ADDRESS:
936 GENEVIEVE STREET
TELEPHONE:
(858) 509-2600
CITY:
SOLANA BEACH
STATE:
CA
ZIP CODE:
92075
CAPACITY:
74
CENSUS:
47
DATE:
10/06/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Cecilia Baeza
TIME COMPLETED:
10:00 AM
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On 10/5/23, LPA Patrick Ma made case management visit to amend report LIC 9099 9/20/23 on behalf of LPA Saraliz Velando.
SUPERVISOR'S NAME:
Renesha Askew
TELEPHONE:
(619) 767-2155
LICENSING EVALUATOR NAME:
Patrick Ma
TELEPHONE:
(619) 767-2218
LICENSING EVALUATOR SIGNATURE:
DATE:
10/06/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/06/2023
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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