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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701434
Report Date: 06/13/2019
Date Signed: 06/13/2019 01:54:50 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:ADVENTURE POINT EARLY LEARNING CENTERFACILITY NUMBER:
376701434
ADMINISTRATOR:NELSON EAGLEFACILITY TYPE:
830
ADDRESS:1805 E. 17TH STREETTELEPHONE:
(303) 968-4321
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:18CENSUS: 0DATE:
06/13/2019
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Timothy Captain and Kim HollowayTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Yolanda Baez met with Applicant Timothy Captain and Director Kim Holloway at the San Diego Child Care Regional Office to comply with Component II orientation requirements.

The following application documents were reviewed and received during this visit which included: LIC 200A (Application) all changes have been made, LIC 308 for Kim Holloway and an acting director in her absence, LIC 401 (all corrections have been made), LIC 500 (all corrections have been made), Job Descriptions (all items listed on the Notice of Incomplete Application have been made), In Service Training (all items listed on the Notice of Incomplete Application have been made), LIC 999: Facility Sketch (all items listed on the Notice of Incomplete Application have been made), LIC 610 (all items listed on the Notice of Incomplete Application have been made), Employee Handbook (all items listed on the Notice of Incomplete Application have been made), Sample Menu (all items listed on the Notice of Incomplete Application have been made), Parent Handbook (all items listed on the Notice of Incomplete Application have been made), All pending items for Timothy Captain have been submitted, and documents submitted for Kim Holloway are the LIC 9108 and statement declining the Influenza vaccine.

Outstanding documents or items needed to complete the application are: certificate of completion of 8 hour preventative health course for Kim Holloway, portions added to the sample menu, and a mortgage statement/receipt for the rent being paid.

Pre-licensing inspection is tentatively scheduled for 06/26/19 at 9:30am pending receipt of STD850 (Fire Inspection Request) and LIC 404.

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

DATE: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
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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