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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701231
Report Date: 07/13/2023
Date Signed: 07/13/2023 04:38:47 PM

Document Has Been Signed on 07/13/2023 04:38 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:ALPINE CHILDREN'S ACADEMYFACILITY NUMBER:
376701231
ADMINISTRATOR:STEPHANIE FREEMANFACILITY TYPE:
850
ADDRESS:2403 ALPINE BOULEVARDTELEPHONE:
(619) 445-5462
CITY:ALPINESTATE: CAZIP CODE:
91901
CAPACITY: 50TOTAL ENROLLED CHILDREN: 32CENSUS: 18DATE:
07/13/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:05 PM
MET WITH:Stephanie FreemanTIME COMPLETED:
04:45 PM
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On 07/13/2023 at 03:45 PM Licensing Program Analyst (LPA) Dana Stevens conducted a Case Management inspection as a result of a technical violation noted during a complaint inspection.

On 03/31/2023, An Unusual Incident occurred that neither Director nor Licensee reported to the Licensing Department by phone or in writing within the required time frame.

LPA reviewed reporting responsibilities with Director and a Technical Violation was issued.

Exit interview was conducted and copy of this report and appeal rights were provided to Licensee. Notice of Site visit must be posted for 30 days.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
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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