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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701546
Report Date: 07/12/2023
Date Signed: 08/03/2023 01:21:40 PM

Document Has Been Signed on 08/03/2023 01:21 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:ECS - ST. MATTHEW'S HEAD STARTFACILITY NUMBER:
376701546
ADMINISTRATOR:PATRICIA JAIMEZFACILITY TYPE:
850
ADDRESS:521 EAST 8TH STTELEPHONE:
(619) 512-9886
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 32TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/12/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Nerissa TorralbaTIME COMPLETED:
11:45 AM
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On 7/12/23 at 10:20am, Licensing Program Analyst (LPA), Martha Malane met with Program Manager, Nerissa Torralba and Associate Director, Leticia Alvarez at the San Diego Regional Office. The purpose of today's meeting was to review pending documents listed on the LIC184C - Notice of Incomplete Application.

LPA reviewed and discussed the pending documents in detail with Program Manager, Nerissa Torralba and Associate Director, Leticia Alvarez.

An exit interview was conducted with Program Manager, Nerissa Torralba and Associate Director, Leticia Alvarez.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2023
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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