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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600880
Report Date: 01/26/2023
Date Signed: 01/29/2023 05:02:21 PM

Document Has Been Signed on 01/29/2023 05:02 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:LEARNING ACADEMY, THEFACILITY NUMBER:
376600880
ADMINISTRATOR:SANDRA GEORGEFACILITY TYPE:
850
ADDRESS:11646 RIVERSIDE DRIVETELEPHONE:
(619) 938-0933
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 40TOTAL ENROLLED CHILDREN: 39CENSUS: 37DATE:
01/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Licensee, Sandra George TIME COMPLETED:
01:05 PM
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Licensing Program Analyst (LPA) Jennifer Lott conducted an unannounced Case Management visit. LPA was greeted at the front door by Licensee, Sandra George and was granted entry after identifying herself and disclosing the purpose of her visit.

The visit was initiated due to licensee submitting LIC 309 Administrative Organization and a request for an IMS Plan. During today’s visit, LPA discussed the change of Administrative Organization as well as the IMS plan with the licensee.

No deficiencies were observed at this time. Exit interview conducted and report was reviewed with Licensee, George. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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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