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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701348
Report Date: 01/04/2021
Date Signed: 01/04/2021 12:08:01 PM

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:POWAY COUNTRY PRESCHOOL INFANTFACILITY NUMBER:
376701348
ADMINISTRATOR:DAWN EMIKO RODRIGUEZFACILITY TYPE:
830
ADDRESS:14411 NORWALK LANETELEPHONE:
(858) 486-4420
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:24CENSUS: DATE:
01/04/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Emiko RodriguezTIME COMPLETED:
12:15 PM
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On 1/4/21 Licensing Program Analyst Michael Morales-DeSilvestore conducted a case management tele-visit. Todays visit is for a requested capacity decrease from a current capacity of 24 to a decreased capacity of 16. The facility now serves children ages 0-2 years in rooms 3 and C. Fire Clearance was approved on 8/20/20. Facility Increase is approved and effective 8/26/20.

No Deficiencies cited.

Director was emailed a copy of this report, appeal rights and notice of site visit. Notice of site visit must be posted for 30 days. Director will confirm receipt of the report via email. Confirmation of receipt of the report will serve as directors signature.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestoreTELEPHONE: (619) 767-2208
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2021
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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