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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376619211
Report Date:
12/01/2022
Date Signed:
12/01/2022 11:46:10 AM
Document Has Been Signed on
12/01/2022 11:46 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:
MEHRABLI, CEFRELYN FAMILY CHILD CARE
FACILITY NUMBER:
376619211
ADMINISTRATOR:
MEHRABLI, CEFRELYN
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(760) 529-7107
CITY:
OCEANSIDE
STATE:
CA
ZIP CODE:
92057
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
0
CENSUS:
0
DATE:
12/01/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:10 AM
MET WITH:
Erlinda Batitis
TIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) James Wilkerson arrived at this facility to conduct a Required 1 Year visit. There have no children enrolled since COVID-19 approximately two years. The facility will go into an inactive status at this time.
An exit interview was conducted an a copy of this report and form LIC 9211 (Inactive request) was provided to the facility on this date.
SUPERVISORS NAME
:
Carlos Martinez
LICENSING EVALUATOR NAME
:
James Wilkerson
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/01/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/01/2022
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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