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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700625
Report Date: 06/20/2022
Date Signed: 06/20/2022 10:14:46 AM

Document Has Been Signed on 06/20/2022 10:14 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:BORREGO SPRINGS STATE PRESCHOOLFACILITY NUMBER:
376700625
ADMINISTRATOR:MARTHA DEICHLERFACILITY TYPE:
850
ADDRESS:1315 PALM CANYON DRIVETELEPHONE:
(760) 767-5333
CITY:BORREGO SPRINGSSTATE: CAZIP CODE:
92004
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
06/20/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sherrilynn PolancoTIME COMPLETED:
10:15 AM
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On 6/20/22 @ 10:00am, Licensing Program Analyst, Patrick Ma, made an announced case management visit for the purpose of delivering an amended report originally created on 6/16/22. LPA met with Principal, Sherrilynn Polanco. The office meeting was conducted via MS Teams due to the facility being closed for summer break.

Exit interview conducted and report was reviewed with the facility representative Sherrilynn Polanco. A notice of site visit was given and must remain posted for 30 days.

This report (LIC809), amended report (LIC 9099), appeal rights, notice of site visit will be delivered via email. Facility Representative reply to the email will be considered confirmation of receipt. Facility representative, Sherlynn Polanco, is to print, sign and return a copy of this report once received.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2022
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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