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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604516
Report Date: 06/09/2022
Date Signed: 06/09/2022 10:03:31 AM

Document Has Been Signed on 06/09/2022 10:03 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:WEAVER'S LILAC VILLAFACILITY NUMBER:
374604516
ADMINISTRATOR:GARDNER, BABETTEFACILITY TYPE:
740
ADDRESS:49 AVENIDA DESCANSOTELEPHONE:
(660) 202-7741
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: 0DATE:
06/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tonya WeaverTIME COMPLETED:
10:05 AM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to deliver an amended report for a Pre-Licensing visit conducted on 6/2/2022. LPA was greeted by, identified herself to, and explained the purpose of the visit to Applicant Tonya Weaver.

During today's visit, LPA obtained Tonya Weaver's signature on the amended Pre-Licensing inspection - LIC809.

An exit interview was conducted with Applicant Tonya Weaver, to whom a copy of this report and the Licensee's Rights (LIC9058 01/16) were provided via hard copy.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2022
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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