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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701361
Report Date: 11/16/2021
Date Signed: 11/24/2021 11:15:38 AM

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:FUTURE ACHIEVERS PRESCHOOL/LOGAN HEIGHTS CDCFACILITY NUMBER:
376701361
ADMINISTRATOR:SHANNON HONTZFACILITY TYPE:
850
ADDRESS:3040 IMPERIAL AVENUETELEPHONE:
(619) 947-9689
CITY:SAN DIEGOSTATE: CAZIP CODE:
92102
CAPACITY:64CENSUS: 34DATE:
11/16/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Shannon HontzTIME COMPLETED:
11:45 AM
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On 11/16/2021 at 11:00am, Licensing Program Analyst (LPA), Martha Malane conducted a Case Management inspection for the purpose of amending the Civil Penalty Assessment Caregiver Background Check form LIC421BG issued 10/20/2021. Upon arrival, LPA met with Director, Shannon Hontz and was led on a tour of the facility. There were 34 children and four (4) staff present during today’s inspection.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies cited.

An exit interview was conducted with Director, Shannon Hontz and Ms. Hontz was provided with the following: LIC809, amended LIC421BG, Notice of Site Visit (LIC 9213) and Appeal Rights.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
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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