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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105121
Report Date: 01/12/2023
Date Signed: 01/12/2023 12:31:05 PM

Document Has Been Signed on 01/12/2023 12:31 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:LA MATERNELLEFACILITY NUMBER:
376105121
ADMINISTRATOR:ALEXANDRA CAMACARISFACILITY TYPE:
850
ADDRESS:4848 SEMINOLE DRTELEPHONE:
(858) 888-1351
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 0DATE:
01/12/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Alexandra Camacaris & Botta KolTIME COMPLETED:
11:45 AM
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On 01/12/2023 at 10:30am, Licensing Program Analyst (LPA) Samantha Salunga conducted an announced virtual office meeting with Facility Representatives, Alexandra Camacaris (assigned applicant and center director) and Botta Kol (CFO and husband of Mrs. Camacaris. The purpose of today's meeting is to review the Notice of Incomplete Application (LIC184C) together and address any questions/concerns that they had.

LPA reviewed entire application and observed that the following areas needed updating/correcting: LIC200A, LIC309, LIC401, LIC404, LIC500, LIC610, LIC9148. LIC999, corporation paperwork, job descriptions, personnel policies, in-service training plan, parent handbook, admission agreement, list of furniture, daily schedule, sample menu and completed director's packet. LPA discussed all areas in detail with facility representatives and they confirmed they will submit all discussed corrections to LPA no later than 02/06/2023.

A copy of this report was reviewed and will be e-mailed to Mr. Kol. LPA advised that a response to the email confirming receipt is to be received within twenty-four hours. This will act as his signature on today’s report.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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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