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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105113
Report Date: 11/04/2022
Date Signed: 11/30/2022 01:57:59 PM

Document Has Been Signed on 11/30/2022 01:57 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:CLAIREMONT CANYONS ACADEMY STATE PRESCHOOLFACILITY NUMBER:
376105113
ADMINISTRATOR:VICTORIA PETERSONFACILITY TYPE:
850
ADDRESS:4133 MT ALBERTINE AVENUETELEPHONE:
(619) 605-1350
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 15DATE:
11/04/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Victoria PetersonTIME COMPLETED:
02:00 PM
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THIS IS AN AMENDED COPY OF A VISIT REPORT DELIVERED ON 11/30/22.

On 11/4/22 at 1:00 PM Licensing Program Analyst (LPA) Adrian Mangina conducted a Plan of Correction visit to the child care center to follow-up on deficiency cited during Case Management – Deficiency on 10/3/22.
LPA met with Facility Representative Victoria Peterson. There were 15 children in care with five teachers. Proper ratios and supervision were observed.

During the visit LPA attempted to verify that:

1) staff #1, #2, #4 and #5 have complete staff files

During file review LPA observed that the files for staff #2, #4 and #5 are still not complete.

Exit interview conducted and report was reviewed with the Facility Representative Victoria Peterson. Notice of Site Visit (LIC9213) was provided and must be posted for 30 consecutive days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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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