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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000300
Report Date: 06/27/2023
Date Signed: 06/28/2023 07:28:18 AM

Document Has Been Signed on 06/28/2023 07:28 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:KENSINGTON COMMUNITY CHURCH PRE-SCHOOLFACILITY NUMBER:
372000300
ADMINISTRATOR:ADRIANA DICARLOFACILITY TYPE:
850
ADDRESS:4773 MARLBOROUGH DRIVETELEPHONE:
(619) 280-1610
CITY:SAN DIEGOSTATE: CAZIP CODE:
92116
CAPACITY: 44TOTAL ENROLLED CHILDREN: 29CENSUS: 28DATE:
06/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Adriana Di CarloTIME COMPLETED:
10:45 AM
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On 6/27/23 at 10:05am, Licensing Program Analyst (LPA), Martha Malane conducted an unannounced case management inspection for the purpose of amending a report dated 10/17/22. Upon arrival, LPA met with Director, Adriana Di Carlo and was led on a tour of the facility. There were 28 children and four (4) staff members present.

No deficiencies cited.

Exit interview was conducted with the Director, Adriana Di Carlo. Notice of Site Visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2023
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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