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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371093
Report Date: 08/09/2023
Date Signed: 08/09/2023 10:22:13 AM

Document Has Been Signed on 08/09/2023 10:22 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:FULLERTON CHILDREN'S ACADEMYFACILITY NUMBER:
304371093
ADMINISTRATOR:CALERO, MARGARITAFACILITY TYPE:
850
ADDRESS:3516 W. COMMONWEALTH AVENUETELEPHONE:
(714) 680-0567
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY: 62TOTAL ENROLLED CHILDREN: 62CENSUS: 28DATE:
08/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Margarita Calero, DirectorTIME COMPLETED:
10:45 AM
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LPAs Quinto and Duron conducted a Case Management inspection on today's date.

The purpose of today's Case Management inspection is to obtain signature on the amended LIC 9099 Complaint Report and update the finding from unsubstantiated to needs further investigation.

This report and the amended report were discussed, and both reports were signed, and a copy left with the director.

Exit Interview was conducted.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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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