Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700272
Report Date: 03/13/2019
Date Signed 03/13/2019 02:28:35 PM

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:A CHILDREN'S GARDEN - LEUCADIAFACILITY NUMBER:
376700272
ADMINISTRATOR:HEATHER ADDY CRIDERFACILITY TYPE:
850
ADDRESS:1421 BURGUNDY ROADTELEPHONE:
(760) 436-5370
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:44CENSUS: DATE:
03/13/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Assisant Director Melisa WickhamTIME COMPLETED:
02:30 PM
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Licensing Program Analyst, Joelle Redding, made an unannounced visit to deliver an LIC 809 and 809C for an annual visit conducted on 3/6/19. The reports were initially generated on the incorrect facility number.

Notice of Site Visit was posted and will remain posted for 30 days.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2019
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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