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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700416
Report Date: 03/22/2024
Date Signed: 03/22/2024 01:58:59 PM

Document Has Been Signed on 03/22/2024 01:58 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SKYLINE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376700416
ADMINISTRATOR:JACQUELINE SERRANOFACILITY TYPE:
850
ADDRESS:11330 CAMPO ROADTELEPHONE:
(619) 415-5485
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 72TOTAL ENROLLED CHILDREN: 69CENSUS: 52DATE:
03/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Rosa JohnsonTIME COMPLETED:
02:15 PM
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On 3/22/2024 at 1:20pm, Licensing Program Analyst (LPA), Vicky Williamson conducted an unannounced case management inspection to deliver an amended report originally created on 1/25/2024. LPA met with Facility Representative, Rosa Johnson and was led on a tour of the facility. There were 52 napping children with five (5) staff members.

An amended report was delivered to reflect corrections to Title 22 regulations noted on original report dated 1/25/2024. The amended report reflects Title 22 Regulation Responsibility for Providing Care and Supervision 101229(a)(1).

No deficiencies cited during today’s inspection. Exit interview conducted and report was reviewed with the Facility Representative, Rosa Johnson. A copy of the report and Appeal Rights were provided to the facility representative. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
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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