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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700705
Report Date: 03/15/2023
Date Signed: 03/15/2023 02:05:38 PM

Document Has Been Signed on 03/15/2023 02:05 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:FOSTER EXTENDED DAY PROGRAMFACILITY NUMBER:
376700705
ADMINISTRATOR:ANJELICA DIAZFACILITY TYPE:
840
ADDRESS:6550 51ST STREETTELEPHONE:
(858) 688-2156
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 25DATE:
03/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Anjelica DiazTIME COMPLETED:
02:20 PM
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On 3/15/2023 @ 1:30PM, Licensing Program Analysts (LPAs) Nancy Diaz and Sherlynn Banas conducted an unannounced case management inspection. The purpose of this inspection is to deliver an amended LIC 809D for the inspection conducted on 3/10/23. LIC 809D created on LIC 3/10/23 did not have the appropriate language.

No deficiency cited today.

Exit interview conducted with Anjelica Diaz, Site Supervisor. A copy of this report and the amended LIC 809D were provided to Ms. Diaz today.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2023
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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