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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701494
Report Date: 08/19/2021
Date Signed: 08/19/2021 10:43:17 AM

Document Has Been Signed on 08/19/2021 10:43 AM - 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:CHILDREN OF LIFE ACADEMYFACILITY NUMBER:
376701494
ADMINISTRATOR:KIM PARGOFACILITY TYPE:
850
ADDRESS:880 KUHN DRIVETELEPHONE:
(619) 656-0131
CITY:CHULA VISTASTATE: CAZIP CODE:
91914
CAPACITY: 55TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/19/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Barbara Richardson TIME COMPLETED:
10:30 AM
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On 08/19/21 at 9:00 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an office meeting with President, Barbara Richardson in order to comply with Component II orientation requirements.

LPA reviewed the following documents: LIC401 - Monthly Operating Statement, LIC999 - Indoor and Outdoor Facility Sketches, Personnel Policies, In-Service Training, List of furniture and Control of Property. The reviewed documents are complete.

The following remains pending:
    • Job descriptions - reflecting the lines of supervision for each position.

LPA discussed the pending document in detail. Pending document shall be submitted to the department by: 08/23/21.

An exit interview was conducted with the president. The following was discussed and provided: LIC809 and appeal rights.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2021
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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