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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105151
Report Date: 10/02/2023
Date Signed: 10/02/2023 04:48:51 PM

Document Has Been Signed on 10/02/2023 04:48 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:BLOOMING HOUSE MONTESSORI SCHOOLSFACILITY NUMBER:
376105151
ADMINISTRATOR:UNKNOWNFACILITY TYPE:
850
ADDRESS:267 N EL CAMINO REAL STE. JTELEPHONE:
(619) 288-0316
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 0DATE:
10/02/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Ivonne Aguilar & Josue CervantesTIME COMPLETED:
04:30 PM
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On 10/02/2023 at 3:30pm, Licensing Program Analyst (LPA), Samantha Clenista virtually (via Zoom) met with licensee representatives, Ivonne Aguilar (CEO/Director) & Josue Cervantes (Business Administrator) for an office meeting. The purpose of today's meeting was to review pending documents listed on the LIC184C - Notice of Incomplete Application (NOIA) that was sent to facility representatives on 09/18/2023.

LPA reviewed and discussed the pending documents listed in LIC184C in detail and answered any questions the facility representatives had.

An exit interview was conducted with licensee representatives, Ms. Aguilar and Mr. Cervantes.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2023
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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