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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700099
Report Date: 07/19/2023
Date Signed: 07/19/2023 10:15:26 AM

Document Has Been Signed on 07/19/2023 10:15 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 STE 110
SAN DIEGO, CA 92108
FACILITY NAME:BIRD ROCK ELEMENTARYFACILITY NUMBER:
376700099
ADMINISTRATOR:JARED WINDTFACILITY TYPE:
840
ADDRESS:5371 LA JOLLA HERMOSA AVENUETELEPHONE:
(858) 967-6544
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
07/19/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lucelyna GodwinTIME COMPLETED:
10:30 AM
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On 7/19/23 at 9:45 AM, Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced case management site inspection. Upon arrival, LPA met with Lucelyna Godwin, Association Program Specialist. This facility requested to add a second room for UTK age group with no change in capacity. The program requested to operate in the following rooms: Room B3. The facility is currently licensed to operate in the auditorium. Fire clearance was granted on 06/29/2023. There were no children present during inspection as it is summer break.

The above classroom was inspected during this visit. During the inspection, LPA observed the indoor play space to be complete with age-appropriate furniture and equipment, including tables, chairs, cubbies, bookshelves, and other activity supplies for the children. There is an operational carbon monoxide detector and 3A40BC fire extinguisher in the classroom. There is no change in facility's outdoor play areas or bathroom facilities. There is a separate staff restroom. Children will be escorted to/from the bathrooms at all times. The classrooms were not measured as they are exempt from square footage requirements due to Health and Safety Code Section 1596.806 as long as they are certified by the principal for use as classrooms during the day. Food preparation for snacks will be done in auditorium. Isolation for ill children will be the school nurse's office.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website. Please go to www.ccld.ca.gov and click on “Receive Important Updates,” then enter your email address and choose which program you would like to subscribe to and click “subscribe.”

A license for 60 children (Transitional kinder thru 14-years-old) in Auditorium and Room B3 is granted and effective today's date, 07/19/2023. Exit interview conducted with facility Representative, Lucelyna Godwin and copy of this report, appeals rights, and Notice of Site Visit provided. Notice of Site Visit form shall be posted for 30 consecutive days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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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