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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701426
Report Date: 06/26/2019
Date Signed: 06/26/2019 02:46:30 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:OPENMINDS ADAMS ELEMENTARYFACILITY NUMBER:
376701426
ADMINISTRATOR:CHRISTINE D'AMICOFACILITY TYPE:
840
ADDRESS:4672 35TH STREETTELEPHONE:
(619) 665-1264
CITY:SAN DIEGOSTATE: CAZIP CODE:
92116
CAPACITY:30CENSUS: 0DATE:
06/26/2019
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Christine D'AmicoTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Yolanda Baez met with Applicant, Christine D'Amico, at the San Diego Child Care Regional Office to comply with Component II orientation requirements.

The following application documents were reviewed during this visit which included: Providing additional information regarding the name change for Articles of Incorporation and By- laws, updating and removing "Harmonium Inc." from the control of property/permit, Parent Handbook to change page 5 of the admission agreement it states "NUA Sparrow" on #10 please change the name, Component III orientation certificate for Gladis, TB Tests for Christine D'Amico and Gladis (cannot be more than a year old), Gladis needs proof of enrollment for Administrative course (3 units or may provide completed course with final grade and units earned), please make correction to the IMS plan of Operation to include specific information on storage requirements, training needed, a plan to ensure trained staff are present while children who require IMS are present at the center, and a plan for updating the physician instructions annually, and Influenza vaccine or declaration to opt out of Influenza vaccine for Gladis.

Outstanding documents or items needed to complete the application are the following: the fire clearance, verification of financial information (LIC 404), and the items listed above.

SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
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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