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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
374602824
Report Date:
10/27/2022
Date Signed:
10/27/2022 04:18:15 PM
Document Has Been Signed on
10/27/2022 04:18 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. #109
SAN DIEGO
,
CA
92108
FACILITY NAME:
CPSRC BMDTP-LAKESIDE
FACILITY NUMBER:
374602824
ADMINISTRATOR:
NANCY ELDRIDGE
FACILITY TYPE:
775
ADDRESS:
11757 TOPO LANE
TELEPHONE:
(619) 561-7405
CITY:
LAKESIDE
STATE:
CA
ZIP CODE:
92040
CAPACITY:
30
CENSUS:
DATE:
10/27/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
02:53 PM
MET WITH:
TIME COMPLETED:
02:54 PM
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LPA Correia attempted to conduct an annual visit. Upon arrival cleints and staff had departed for the day. LPA will attempt another visit at a later date.
SUPERVISORS NAME
:
Simon Jacob
LICENSING EVALUATOR NAME
:
Debbie Correia
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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