Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700477
Report Date: 01/15/2016
Date Signed 01/15/2016 02:27:50 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:SAY-ELLEN BROWNING SCRIPPS EXTENDED DAYFACILITY NUMBER:
376700477
ADMINISTRATOR:TOM WEBERFACILITY TYPE:
840
ADDRESS:11778 CYPRESS CANYON ROADTELEPHONE:
(858) 693-8593
CITY:SAN DIEGOSTATE: CAZIP CODE:
92131
CAPACITY:105CENSUS: 9DATE:
01/15/2016
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Tom WeberTIME COMPLETED:
03:00 PM
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Nancy Diaz, Licensing Program Analyst (LPA) conducted an unannounced case management visit today. Toured all the rooms (501, 502 and 157) with site supervisor Tom Weber. Observed present today were 9 TK children with staff Manda Owen and Madhavi Kashappa. Staff and random children's records. Updated LIC 500 & LIC 610 were provided today.

Facility maintains a carbon monoxide present in all the rooms. A fire drill was conducted on 1/8/2016. Mr. Weber's CPR/First aid certificate is valid thru October 2017. Both staff present today are also current with CPR/First aid.

NO DEFICIENCY CITED TODAY.
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2016
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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