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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376701313
Report Date:
01/19/2022
Date Signed:
01/19/2022 10:41:08 AM
Document Has Been Signed on
01/19/2022 10:41 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
,
3737 MAIN STREET, STE 700
RIVERSIDE
,
CA
92501
FACILITY NAME:
EES VISTA INNOVATION EARLY EDUCATION CENTER
FACILITY NUMBER:
376701313
ADMINISTRATOR:
ABBEY CANUM
FACILITY TYPE:
850
ADDRESS:
836 OLIVE AVENUE
TELEPHONE:
(760) 726-2170
CITY:
VISTA
STATE:
CA
ZIP CODE:
92083
CAPACITY:
60
TOTAL ENROLLED CHILDREN:
60
CENSUS:
5
DATE:
01/19/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Melissa Duffey
TIME COMPLETED:
10:47 AM
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Licensing Program Analysts (LPA) Otsanya Cameron and Anastasia Flores arrived at the facility on a case management inspection. The purpose of this visit is to follow-up on an Unusual Incident Report (UIR) submitted to Community Care Licensing (CCL) by the facility on or around 1/5/2022. The preschool classroom referenced in the UIR was closed due to COVID-19 on this date. A follow up visit will be conducted on a later date.
SUPERVISORS NAME
:
Pauline Beschorner
LICENSING EVALUATOR NAME
:
Otsanya Cameron
LICENSING EVALUATOR SIGNATURE
:
DATE:
01/19/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/19/2022
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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