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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701527
Report Date: 01/17/2023
Date Signed: 01/19/2023 09:51:51 AM

Document Has Been Signed on 01/19/2023 09:51 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:VILLAGE PRESCHOOLFACILITY NUMBER:
376701527
ADMINISTRATOR:EILEEN RODRIGUEZFACILITY TYPE:
850
ADDRESS:600 6TH STREETTELEPHONE:
(619) 522-8915
CITY:CORONADOSTATE: CAZIP CODE:
92118
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 16DATE:
01/17/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Martiza ArellanoTIME COMPLETED:
11:25 AM
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On 01/17/2023 at 9:45 am, Licensing Program Analyst (LPA) Michelle Hood conducted a case management inspection for the purpose for Lead testing/Exceedance. LPA advised Maritza Arellano, Administrative Assistant of Special Programs the purpose and LPA was granted entry.

On 12/07/2022, the sink faucet in classroom #710 tested positive; however, the classroom has not been used for preschool children. The main water line and piping line have been replaced. The faucet has not been used since the positive report. The facility has a second lead testing scheduled on 01/18/2023.

LPA asked Arellano to provide LPA a copy of the new testing summary after the inspection.

An exit interview was conducted, and report was reviewed with Arellano.

Notice of Site Visit will be emailed and will remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. A copy of this report will be emailed to Arellano and Arellano was advised that acknowledgment and receipt of the report are to be received within twenty-four hours.

This report was emailed due to computer and printer error.

This is an amended copy, the original is dated 01/17/2023.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
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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