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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376619211
Report Date:
06/18/2024
Date Signed:
06/18/2024 12:58:53 PM
Document Has Been Signed on
06/18/2024 12:58 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
RIVERSIDE SE CC RO
,
3737 MAIN STREET, STE 700
RIVERSIDE
,
CA
92501
FACILITY NAME:
MEHRABLI, CEFRELYN FAMILY CHILD CARE
FACILITY NUMBER:
376619211
ADMINISTRATOR/
DIRECTOR:
MEHRABLI, CEFRELYN
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(760) 529-7107
CITY:
OCEANSIDE
STATE:
CA
ZIP CODE:
92057
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
DATE:
06/18/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
12:34 PM
MET WITH:
TIME VISIT/
INSPECTION COMPLETED:
12:56 PM
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SUPERVISORS NAME
:
Carlos Martinez
LICENSING EVALUATOR NAME
:
Kelly Gerth
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/18/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/18/2024
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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