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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600647
Report Date: 01/13/2025
Date Signed: 01/13/2025 10:15:55 AM

Document Has Been Signed on 01/13/2025 10:15 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CAMPO KUMEYAAY HEAD STARTFACILITY NUMBER:
376600647
ADMINISTRATOR/
DIRECTOR:		CRYSTAL KREMENSKYFACILITY TYPE:
850
ADDRESS:39639 OLD HIGHWAY 80TELEPHONE:
(619) 473-9022
CITY:BOULEVARDSTATE: CAZIP CODE:
91905
CAPACITY: 40TOTAL ENROLLED CHILDREN: 32CENSUS: 26DATE:
01/13/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Lary HaneyTIME VISIT/
INSPECTION COMPLETED:
10:20 PM
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On 1/13/2025 at 9:50 a.m., Licensing Program Analyst (LPA) Angela Nguyen conducted an unannounced case management inspection to deliver an amended report created on 11/18/2024. LPA met with Licensee Representative, Lari Haney. There were 26 children and 4 teachers and 3 aides.

No Deficiencies were cited during this inspection.

An exit interview was conducted with the Licensee Representative, Lari Haney. A Notice of Site Visit (LIC 9213) and a copy of this report was provided to licensee representative. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. LPA provided Notice of Site Visit and observed it being posted at the facility.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Angela Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2025
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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