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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701246
Report Date: 03/29/2021
Date Signed: 03/29/2021 11:57:41 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:OCEANSIDE SHINING STARS PRESCHOOLFACILITY NUMBER:
376701246
ADMINISTRATOR:CHRISTINA CRUZFACILITY TYPE:
850
ADDRESS:1122 SOUTH COAST HIGHWAYTELEPHONE:
(760) 435-0713
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:28CENSUS: 18DATE:
03/29/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH: Shams Nassar- OwnerTIME COMPLETED:
12:10 PM
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 On 3/29/21 Licensing program analyst (LPA) Otsanya Cameron conducted a case management visit in response to an unusual incident report the occured on 3/12/2021. LPA conducted a physical plant inspection and took census.

Based on information obtained from interviews and other evidence, there was no violation of Title 22 regulations at this time however Technical Assistance was provided.

An exit interview was conducted and a copy of this report was provided to Shams Nassar- Owner.


A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021
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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