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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701366
Report Date: 04/13/2023
Date Signed: 04/13/2023 10:42:55 AM


Document Has Been Signed on 04/13/2023 10:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:IMPERIAL LEARNING ACADEMY SCHOOL-AGEFACILITY NUMBER:
376701366
ADMINISTRATOR:MONICA GOMEZFACILITY TYPE:
840
ADDRESS:7210 LISBON STREETTELEPHONE:
(619) 230-5943
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:48CENSUS: 0DATE:
04/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Monica Gomez, DirectorTIME COMPLETED:
11:00 AM
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On 04/13/2023 at 10:15 am, Licensing Program Analyst (LPA), Michelle Hood, met with Director Monica Gomez. The licensee Mohamed Said was on the phone during the inspection. The purpose of an unannounced inspection was to conduct an annual. There were no children present. The director stated the school-age classroom has been closed due to the pandemic in 2020. The director was provided and completed the LIC 9211- Request For Inactive Child Care License Status. The director and licensee are requesting to be placed on Inactive Status 04/13/2023 to 05/01/2023.

An exit interview was conducted with the licensee and director. NOTICE OF SITE VISIT WAS GIVEN AND WILL REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2023
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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