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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626922
Report Date: 03/06/2023
Date Signed: 03/08/2023 02:47:30 PM

Document Has Been Signed on 03/08/2023 02:47 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:WANG, DAVID & SALLEW, YEZINA FAMILY CHILD CAREFACILITY NUMBER:
376626922
ADMINISTRATOR:DAVID WANG & YEZINA SALLEWFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 228-7076
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
03/06/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:David Wand and Yezinba SallewTIME COMPLETED:
12:00 PM
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THIS IS AN ELECTRONIC COPY OF A TYPEWRITTEN REPORT DUE TO A SYSTEM ERROR.

Due to technical difficulties LPA unable to complete appointment and unable to access FAS report. LPA will return when computer is working to provide full report.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2023
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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