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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701430
Report Date: 05/16/2019
Date Signed: 05/16/2019 02:45:05 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:VILLAGE BLOOM CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376701430
ADMINISTRATOR:ALISON WACHTELFACILITY TYPE:
850
ADDRESS:448 RANCHO SANTA FE ROADTELEPHONE:
(760) 846-9044
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:27CENSUS: 0DATE:
05/16/2019
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Alison WachtelTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Yolanda Baez met with Alison Wachtel at the San Diego Child Care Regional Office to comply with Component II orientation requirements.

The remaining application documents were reviewed and received during this visit which included: Updated Articles of Incorporation and By- Laws (to indicate the change of name), Paperwork for Pauline (Designated Director),and LIC 404 (Financial Information Release and Verification). Pending requirements listed on the Notice of Incomplete Application (NOI) dated 05/16/19 were reviewed and discussed.

Outstanding documents or items needed to complete the application are: the items listed on the NOI dated 05/16/19 which was give to Ms. Wachtel today, the fire clearance, and verification of financial information (LIC 404).

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

DATE: 05/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
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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