Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600287
Report Date: 10/12/2017
Date Signed: 10/12/2017 09:26:17 AM

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:CAJON VALLEY STATE PRESCHOOL-RIOS ELEMENTARYFACILITY NUMBER:
376600287
ADMINISTRATOR:MARIA KEHOEFACILITY TYPE:
850
ADDRESS:14314 RIOS CANYON ROADTELEPHONE:
(619) 588-3090
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY:25CENSUS: 17DATE:
10/12/2017
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Terre HannaTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Farah Tanous made an unannounced inspection at the facility. The purpose of the inspection was to obtain signatures and deliver amended reports, LIC 809, LIC 809C, and LIC 809D, for An Annual Random inspection dated 10/04/2017. Upon arrival, LPA Tanous met with Lead Teacher, Tere Hanna. There were 17 children present with three qualified teachers. LPA obtained necessary signatures and delivered the amended reports.

During the inspection, LPA also took measurements of Classroom # 4, which measured 29 feet X 31 feet= 899 square feet, which is sufficient for 25 children. The restroom used by the preschool has three toilets and 4 sinks.

No deficiencies observed in the areas inspected during today's visit. Licensee’s (LIC 9058 01/16) rights were provided. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit. Exit interview conducted. Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Farah TanousTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2017
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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