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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600851
Report Date: 08/17/2023
Date Signed: 08/17/2023 01:57:40 PM

Document Has Been Signed on 08/17/2023 01:57 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:SAY- MARVIN EXTENDED DAY PROGRAMFACILITY NUMBER:
376600851
ADMINISTRATOR:SARANN SOKFACILITY TYPE:
840
ADDRESS:5720 BRUNSWICK AVENUETELEPHONE:
(858) 212-4703
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY: 112TOTAL ENROLLED CHILDREN: 112CENSUS: 0DATE:
08/17/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Iriz StoneTIME COMPLETED:
02:10 PM
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On 8/17/2023 @ 1:30PM, Licensing Program Analyst (LPA) Nancy Diaz conducted an announced case management inspection. Met with Iriz Stone, Senior Program Director. Also present today were staff Sarann Sok, Site Director and Brianna Mendoza, teacher.

Licensee has requested a decrease in capacity to 70 school-age children and to add the Multi-Purpose room to their licensed area. Licensee notified the department that their children will not access the cafeteria anymore.

The classroom was observed to have age-appropriate equipment and supplies. They have exclusive use of the children's bathroom in Building 3.

Exit interview was conducted with Iriz Stone. A copy of this report and appeal rights were provided today.

NO DEFICIENCY CITED TODAY.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2023
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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