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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000300
Report Date: 01/25/2024
Date Signed: 01/25/2024 12:13:12 PM


Document Has Been Signed on 01/25/2024 12:13 PM - 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:44CENSUS: 27DATE:
01/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Adriana DiCarloTIME COMPLETED:
12:30 PM
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On 01/25/2024 at 11:46 AM Licensing Program Analyst (LPA), Dana Stevens, conducted an unannounced case management visit for the purpose of amending case management report dated 01/12/2024. LPA met with Director, Adriana DiCarlo and informed her of the purpose of the visit. There were 27 children and 7 staff present at the time of this visit.

An exit interview was conducted and a copy of this report was provided to Director.
The Notice of Site Visit (LIC 9213) is to be posted for thirty (30) days
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2024
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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