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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372003108
Report Date: 10/11/2022
Date Signed: 10/11/2022 04:34:01 PM

Document Has Been Signed on 10/11/2022 04:34 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:SAM & ROSE STEIN EDUCATION CENTERFACILITY NUMBER:
372003108
ADMINISTRATOR:CHAYO CHAVEZFACILITY TYPE:
840
ADDRESS:6145 DECENA DRIVETELEPHONE:
(619) 281-5511
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: DATE:
10/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Jamison Brida and Chayo ChavezTIME COMPLETED:
04:40 PM
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On 10/11/22, Licensing Program Analyst (LPA), Tyra Block, conducted an unannounced visit to follow up on self-reported incident. Present at the facility were 7 children and 3 staff.

LPA interviewed staff members Jamison and Valerie, Franklin was absent and not available for interview. They were present the on 9/30/22 and witnessed the incident. Program Director, Chayo Chavez also provided insight to program and incident involving child #1. Ms. Chavez stated that incidents like this happen from time to time and protocols were followed. Staff stated the incident was a rare occurrence for the child involved and since that day there has been no other similar incidents.

No deficiencies were cited during this visit. LPA explained a follow up visit or interview may be conducted if deemed necessary.

An exit interview was conducted with facility representative, Chayo Chavez. This licensing report and Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2022
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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