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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701365
Report Date: 04/25/2022
Date Signed: 04/25/2022 04:04:41 PM


Document Has Been Signed on 04/25/2022 04:04 PM - 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:LA PETITE ETOILE 360 PRESCHOOLFACILITY NUMBER:
376701365
ADMINISTRATOR:JENNIFER NELSONFACILITY TYPE:
850
ADDRESS:4555 PARK BOULEVARDTELEPHONE:
(858) 449-4891
CITY:SAN DIEGOSTATE: CAZIP CODE:
92116
CAPACITY:20CENSUS: 19DATE:
04/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Celine TheanoTIME COMPLETED:
04:30 PM
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On 4/25/2022 at 3:35pm, Licensing Program Analyst (LPA), Martha Malane conducted a case management inspection for the purpose of amending the Civil Penalty Assessment Failure to Correct form LIC421FC issued 4/12/2022. Upon arrival, LPA met with Owner, Celine Theano. There were 19 children and three (3) 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 Owner, Celine Theano. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2022
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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