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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701430
Report Date: 10/20/2022
Date Signed: 10/20/2022 02:03:58 PM


Document Has Been Signed on 10/20/2022 02:03 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:VILLAGE BLOOM CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376701430
ADMINISTRATOR:PAULINE ASCUEFACILITY TYPE:
850
ADDRESS:448 RANCHO SANTA FE ROADTELEPHONE:
(760) 704-8314
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:48CENSUS: 3DATE:
10/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Director Pauline AscueTIME COMPLETED:
02:10 PM
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On 10/20/2022 @ 1:50 p.m., Licensing Program Analyst (LPA), Joelle Redding, made an unannounced visit to evaluate the facility request for use of additional outdoor space.

The facility has added a patio space to the lower classroom building that they intend to use as an atelier/art area. No increase in capacity has been requested.

LPA inspected the space. It is free of hazards and appropriate for use. 6' fencing with one exit gate with a high latch.

The request is granted.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2022
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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