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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300358
Report Date: 07/20/2021
Date Signed: 07/20/2021 03:12:38 PM

Document Has Been Signed on 07/20/2021 03:12 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:COLES COTTAGE ACADEMYFACILITY NUMBER:
376300358
ADMINISTRATOR:COSTA,WEERATUNGAFACILITY TYPE:
850
ADDRESS:505 CIVIC CENTER DRTELEPHONE:
(949) 836-4465
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 38TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/20/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Applicant Weeratunga CostaTIME COMPLETED:
03:20 PM
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On 07/20/2021 Licensing Program Analysts (LPA) James Wilkerson, Jeanette Sanchez and Susan Brewer, arrived at the facility for the purpose of conducting a Pre-Licensing Inspection at the request of Applicant Weeratunga Costa. The LPAs were greeted by Licensing Director Cheryl Gillins, the pending new owner Weeratunga Costa, and granted entry to tour the facility inside and out.

Measurements were taken of the Indoor Activity and Outdoor Activity Areas designated for the preschool program, however the LIC999 facility sketches will need to be updated to confirm and designate indoor and outdoor activity areas. Due to time constraints, the Pre-Licensing inspection will be rescheduled for another date to continue the pre-licensing inspection, the application review, Component II consultation and determination of usable space for the preschool program.

This report was reviewed and provided to the applicant Weeratunga Costa, at the close of the inspection.
SUPERVISORS NAME: Telma Sandoval
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2021
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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