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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701519
Report Date: 05/11/2022
Date Signed: 05/11/2022 11:52:42 AM

Document Has Been Signed on 05/11/2022 11:52 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:COZY CUBS 2FACILITY NUMBER:
376701519
ADMINISTRATOR:VIRGINIA ANDRADEFACILITY TYPE:
850
ADDRESS:4351 PARKS AVETELEPHONE:
(858) 243-9287
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 0DATE:
05/11/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Annette KurtenbachTIME COMPLETED:
12:00 PM
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On 5/11/2022 at 10:30am, Licensing Program Analyst (LPA), Martha Malane met with licensee representative, Annette Kurtenbach for an office meeting at the San Diego Regional Office. The purpose of today's meeting was to review pending documents listed on the LIC184C - Notice of Incomplete Application.

LPA reviewed and discussed the pending documents in detail with licensee representative, Annette Kurtenbach. Annette submitted updated documents to CCL during this meeting.

An exit interview was conducted with licensee representative, Annette Kurtenbach.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2022
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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