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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700119
Report Date: 04/14/2023
Date Signed: 04/14/2023 11:02:34 AM

Document Has Been Signed on 04/14/2023 11:02 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:EL CAMINO PRESCHOOLFACILITY NUMBER:
376700119
ADMINISTRATOR:BURTON, HEIKEFACILITY TYPE:
850
ADDRESS:2002 CALIFORNIA STREETTELEPHONE:
(760) 722-5050
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY: 69TOTAL ENROLLED CHILDREN: 69CENSUS: 55DATE:
04/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Heike BurtonTIME COMPLETED:
11:15 AM
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On April 14, at 10:14am Licensing Program Analyst(LPA) Courtnee Peebles arrived at the facility to conduct a case management visit. LPA toured the facility inside and out and took a census. LPA arrived at the facility to deliver an amended 809D for an annual visit conducted on 01/26/2023. LPA explained to the director the incorrect LIC form number was placed on the deficiency page 809D. A corrected form was given today.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Courtnee Peebles
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2023
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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