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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701228
Report Date: 12/27/2022
Date Signed: 12/27/2022 12:42:59 PM

Document Has Been Signed on 12/27/2022 12:42 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CHILDREN'S CHOICE ACADEMYFACILITY NUMBER:
376701228
ADMINISTRATOR:SHANNON SPENCERFACILITY TYPE:
850
ADDRESS:12464 WOODSIDE AVENUETELEPHONE:
(619) 561-8880
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 17DATE:
12/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jennifer GrawvunderTIME COMPLETED:
12:50 PM
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On 12/27/22 @ 12:30 PM LPA Annette Sutherland conducted a case management visit at the facility. Purpose of the visit was to deliver an amended report.

No deficiencies were cited , licensee was provided a copy of amended report.

Exit interview conducted and report was reviewed with Jennifer Grawvender . A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2022
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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