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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701447
Report Date: 09/12/2023
Date Signed: 09/12/2023 02:29:16 PM

Document Has Been Signed on 09/12/2023 02:29 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:HSHMC CHILD CARE CENTERFACILITY NUMBER:
376701447
ADMINISTRATOR:KIM DAVIS MANCUSOFACILITY TYPE:
830
ADDRESS:3910 UNIVERSITY AVENUE STE 100TELEPHONE:
(619) 255-9546
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
09/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Kimberly Davis MancusoTIME COMPLETED:
01:50 PM
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On September 12th, 2023 at 1:30 PM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted an unannounced Case Management inspection with the Director Kimberly Mancuso to amend a prior complaint investigation report, created on 07/12/2023. LPA advised the director of the inspection's purpose and LPA was granted facility entry. Present in the daycare were two (2) infants, three (3) teachers.

The director was provided with the amended report and signed this amended report.

A Notice of Site Visit (LIC 9213) is to be posted for thirty (30) days. LPA observed the director post this notice. An exit interview was conducted with the director. Licensee Rights (LIC 9098) along with a copy of this report was provided to Director Kimberly Davis Mancuso.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2023
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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