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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701276
Report Date: 10/14/2019
Date Signed: 10/14/2019 03:50:39 PM

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:HAPPY TIMES CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376701276
ADMINISTRATOR:BELEN ESTEBANFACILITY TYPE:
830
ADDRESS:755 CIVIC CENTER DRIVETELEPHONE:
(760) 295-9475
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:22CENSUS: 5DATE:
10/14/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Diana Martinez, Lead TeacherTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Ericka Smith met with Diana Martinez, Lead Teacher, to conduct a case management.
SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Ericka SmithTELEPHONE: (951) 255-4577
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019
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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