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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005166
Report Date: 09/06/2022
Date Signed: 09/06/2022 01:32:16 PM

Document Has Been Signed on 09/06/2022 01:32 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:JEWISH COMMUNITY CENTER; M. LARRY LAWRENCE BRANCHFACILITY NUMBER:
372005166
ADMINISTRATOR:FRAN FORMANFACILITY TYPE:
850
ADDRESS:4126 EXECUTIVE DRIVETELEPHONE:
(858) 362-1171
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY: 241TOTAL ENROLLED CHILDREN: 241CENSUS: DATE:
09/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Director Fran DrosmanTIME COMPLETED:
01:30 PM
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On 9/6/2022 @ 12:10 p.m., Licensing Program Analyst (LPA), Joelle Redding, made an unannounced visit to follow up on two self-reported incidents wherein alleged interactions between two parties created a potential Title 22 violation of an individual's personal rights or was due to a lack of supervision.

During today's visit, LPA interviewed the Director and potential witnesses and reviewed relevant documentation.

No evidence of regulatory violation was determined. No deficiencies are cited.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2022
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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