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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701430
Report Date: 06/23/2023
Date Signed: 06/23/2023 02:06:57 PM


Document Has Been Signed on 06/23/2023 02:06 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: 0DATE:
06/23/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Director Kendra deGrootTIME COMPLETED:
02:15 PM
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On 6/23/2023 @ 9:00 a.m., Licensing Program Analyst (LPA), Joelle Redding, made an unannounced visit to assess the corrections made for the Type B deficiency cited during the annual visit on 5/1/2023. During this visit, LPA also delivered an amended LIC 809C and LIC809D. The amendment removed the boulder in the sandbox from the required plan of correction.

LPA evaluated the outdoor space for the corrections submitted on 5/31/23 for the pig enclosure and 6/12/23 for the boulder. A salt lick water dispenser has been installed and there are shallow water dishes in the pig enclosure with no more than an inch water. The large boulder in the grassy area has been made inaccessible by the placement of picnic tables around it to prevent climbing but maintaining the asthetic of the playground. Appropriate supervision will remain in place at all times.

The Type B deficiency with regard to Staff #1 was cleared on 5/19/23.

Exit interview was conducted and report was reviewed with Director Kendra DeGroot.

NOTICE OF SITE VISIT WAS GIVEN AND WILL REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
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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