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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701490
Report Date: 04/06/2021
Date Signed: 04/06/2021 10:45:52 AM

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:FAITH CHAPEL LEARNING ACADEMYFACILITY NUMBER:
376701490
ADMINISTRATOR:STEPHANIE SMITHFACILITY TYPE:
830
ADDRESS:9400 CAMPO ROADTELEPHONE:
(619) 567-7557
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:26CENSUS: 0DATE:
04/06/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Stephanie SmithTIME COMPLETED:
10:45 AM
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On 04/06/2021 at 10:00am, Licensing Program Analyst (LPA), Martha Malane met with Director, Stephanie Smith. Due to COVID-19 state of emergency, this meeting was conducted via video conferencing (Teams). The purpose of today's meeting is to review the LIC184C and answer any questions the director may have.

LPA reviewed the application and observed the following areas need updated/corrected: application, LIC308, LIC309, LIC401, LIC404, LIC503, LIC508, LIC999, director qualifications, personnel policies, staff in-service training, admission policies, parent handbook and admissions agreement. LPA discussed these documents in detail with director and she confirmed she will submit the updates/corrections to LPA by 05/06/2021.

A copy of this report was reviewed and will be e-mailed to the director. LPA advised acknowledgement of receipt of the report is to be received within twenty-four hours.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2021
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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