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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105025
Report Date: 09/29/2022
Date Signed: 09/29/2022 04:50:42 PM

Document Has Been Signed on 09/29/2022 04:50 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:CHILDREN'S CHOICE ACADEMYFACILITY NUMBER:
376105025
ADMINISTRATOR:KRISTEN GEORGEFACILITY TYPE:
840
ADDRESS:9748 LOS COCHES ROAD, SUITE 12TELEPHONE:
(619) 561-1178
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 28TOTAL ENROLLED CHILDREN: 29CENSUS: 21DATE:
09/29/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:VP of Opeations, Jennifer Grawvunder TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Jennifer Lott conducted an unannounced Case Management visit. LPA was greeted at the front door by VP of Operations, Jennifer Grawvunder and was granted entry after identifying herself and disclosing the purpose of her visit.

The visit was initiated due to a self-reported incident involving child #1 (C1). The licensee’s authorized representative self-reported this incident by submitting form LIC 624 – Unusual Incident/Injury Report to Community Care Licensing (CCL), which was received in our office on 09/23/2022.

During today’s visit, LPA conducted interviews and obtained additional information.

Based on today’s visit, no deficiencies were observed at this time. Exit interview conducted and report was reviewed with the VP of Operations, Jennifer Grawvunder. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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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