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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136608112
Report Date: 10/27/2022
Date Signed: 10/27/2022 09:47:04 AM

Document Has Been Signed on 10/27/2022 09:47 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:CVUSD - SEA VIEWFACILITY NUMBER:
136608112
ADMINISTRATOR:NANCY MACIASFACILITY TYPE:
850
ADDRESS:2467 SEA SHORE AVE.TELEPHONE:
(760) 848-1030
CITY:SALTON CITYSTATE: CAZIP CODE:
92275
CAPACITY: 20TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/27/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jean Dagarin TIME COMPLETED:
09:14 AM
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On 10/27/22 at 9:00 a.m., Licensing Program Analyst (LPA), Rajani Goudreau met with applicant representative, Jean Dagarin via virtual office Meeting. The purpose of today's meeting was to review the pending documents listed on the LIC184 - Notice of Incomplete Application checklist.

LPA reviewed and discussed the pending documents in detail with applicant representative, Jean Dagarin.

A copy of this report was provided to licensee representative via email. Licensee representative was advised that acknowledgement of receipt of the report is to be received within twenty-four hours.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
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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