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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300206
Report Date: 10/21/2021
Date Signed: 10/21/2021 02:22:28 PM

Document Has Been Signed on 10/21/2021 02:22 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LITTLE ELMSFACILITY NUMBER:
376300206
ADMINISTRATOR:GALEANA-GODINEZ, OSCARFACILITY TYPE:
850
ADDRESS:117 N ELM STTELEPHONE:
(424) 257-2857
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: 11DATE:
10/21/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:06 PM
MET WITH: teacher Yolanda ResendizTIME COMPLETED:
02:46 PM
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On this date, Licensing Program Analyst (LPA) Otsanya Cameron conducted a case management inspection to obtain signatures for report that was initially generated for the facility on 10/18/21. Due to FAS consistency check, all signatures on report were not saved.

Additionally, this visit will serve to follow up on a plan of correction POC found deficient during annual inspection on 10/18/21. LPA O.Cameron conducted a COVID prescreening prior to entry and toured the facility and the following was observed:

LPA arrived at the facility and was met with facility representative Yolanda Resendiz. Staff states the Director nor Licensee are on site or available at this time.

LPA observed 2 additional staff in ratio with a total of 11 children. During record review, LPA found that 1 staff is an uncleared adult and the other staff in ratio has an eligible clearance but not associated to the facility.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Otsanya Cameron
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2021
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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