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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701520
Report Date: 06/21/2022
Date Signed: 06/21/2022 08:22:25 PM

Document Has Been Signed on 06/21/2022 08:22 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:COZY CUBS 2 INFANTSFACILITY NUMBER:
376701520
ADMINISTRATOR:VIRGINIA ANDRADEFACILITY TYPE:
830
ADDRESS:4351 PARKS AVETELEPHONE:
(858) 243-9287
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/21/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Annette KurtenbachTIME COMPLETED:
04:45 PM
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On 06/21/22 at 3:45pm, Licensing Program Analyst (LPA), Martha Malane arrived at the facility to conduct a second pre-licensing inspection. Upon arrival, LPA, met with Applicant, Annette Kurtenbach and proceeded to tour the facility. The purpose of the inspection was to remeasure the outdoor activity space due to applicant adding activity space for the requested capacity of eight (8) infants.

The outdoor space was inspected and measured a total of 695.78 square feet which is sufficient to accommodate 9 infants, however the applicant is only requesting a capacity of eight (8) infants.

Applicant corrected the following from the first pre-licensing inspection:

1) Extended the outdoor space to accommodate the requested capacity of eight (8) infants


2) Provided one (1) potty chair for potty training infants

An exit interview was conducted with Applicant, Annette Kurtenbach. A license may be granted after a final file review.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2022
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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