<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376300517
Report Date:
10/05/2023
Date Signed:
10/20/2023 02:51:50 PM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
10/20/2023 02:51 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
RIVERSIDE SE CC RO
,
3737 MAIN STREET, STE 700
RIVERSIDE
,
CA
92501
FACILITY NAME:
DE LA CRUZ FAMILY CHILD CARE
FACILITY NUMBER:
376300517
ADMINISTRATOR:
DE LA CRUZ, GRACE
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(858) 275-3890
CITY:
FALLBROOK
STATE:
CA
ZIP CODE:
92028
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
DATE:
10/05/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
08:45 AM
MET WITH:
TIME COMPLETED:
09:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
SUPERVISORS NAME
:
Deborah Mullen
LICENSING EVALUATOR NAME
:
Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/05/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1