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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627287
Report Date: 05/04/2023
Date Signed: 05/04/2023 10:43:10 PM

Document Has Been Signed on 05/04/2023 10:43 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:SOMMERVILLE, JESSICA FAMILY CHILD CAREFACILITY NUMBER:
376627287
ADMINISTRATOR:JESSICA SOMMERVILLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 592-3935
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
05/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Licensee, Jessica Sommerville TIME COMPLETED:
09:55 AM
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Licensing Program Analyst (LPA) Jennifer Lott conducted an unannounced Case Management visit. LPA was greeted at the front door by licensee, Jessica Sommerville, and granted entry after identifying herself and disclosing the purpose of her visit.

The purpose of LPA's visit was to confirm that adult #1 (A1) was residing in the home and had a criminal background clearance.

LPA verified that A1 is residing in the home, however they were not home during LPA's visit. Additionally, A1 has received a criminal background clearance and was associated to the facility.

An exit interview was conducted and reviewed with Licensee, Sommerville. A notice of site visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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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