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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376300501
Report Date:
03/12/2024
Date Signed:
03/12/2024 02:39:53 PM
Document Has Been Signed on
03/12/2024 02:39 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
RIVERSIDE SE CC RO
,
3737 MAIN STREET, STE 700
RIVERSIDE
,
CA
92501
FACILITY NAME:
KLOOSTERMAN FAMILY CHILD CARE
FACILITY NUMBER:
376300501
ADMINISTRATOR:
KLOOSTERMAN, JENNIFER
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(760) 822-1453
CITY:
OCEANSIDE
STATE:
CA
ZIP CODE:
92054
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
60
CENSUS:
2
DATE:
03/12/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:10 PM
MET WITH:
Jennifer Kloosterman
TIME COMPLETED:
02:30 PM
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On the above date and time Licensing Program Analyst (LPA) Keely Messerschmidt arrived at the facility to conduct a case management visit for the purpose of delivering an amended report. LPA met with Licensee Jennifer Kloosterman and explained the reason for visit.
Noticed of Site Visit was provided to Licensee and must remain posted for 30 days. A copy of this report was provided to Licensee Jennifer Kloosterman.
SUPERVISORS NAME
:
Deborah Mullen
LICENSING EVALUATOR NAME
:
Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE
:
DATE:
03/12/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/12/2024
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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