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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136608035
Report Date: 05/04/2021
Date Signed: 05/04/2021 11:41:39 AM

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:UNITED FAMILIES, INC. - CALEXICO PRESCHOOLFACILITY NUMBER:
136608035
ADMINISTRATOR:RUBY JACOBOFACILITY TYPE:
850
ADDRESS:937 HEBER AVENUETELEPHONE:
(760) 768-3835
CITY:CALEXICOSTATE: CAZIP CODE:
92231
CAPACITY:28CENSUS: 13DATE:
05/04/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Elizabeth RoderickTIME COMPLETED:
11:35 AM
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On 5/4/21 at 10:00 AM, Licensing Program Analyst (LPA) Gloria Gonzalez conducted an unannounced Case Management inspection to follow-up on a self-reported possible personal rights violation that occurred on 4/20/21. The inspection was conducted virtually via Facetime, due to the COVID-19 state of emergency. LPA disclosed the purpose of the inspection and was granted a video tour into the facility by staff member, Elizabeth Roderick. Roderick states there were 13 children 2 staff members and the cook, at the time of the inspection.

The incident that occurred on 4/20/21. Interviews were conducted with the 3 staff members and 8 children.

Director has already sent LPA the children's roster.
 
A copy of the report, appeal rights (LIC 9058), and LIC9213 will be e-mailed to Roderick and Roderick was advised that acknowledgement of the receipts of the report and appeal rights are to be received within twenty-four hours.
 
An exit interview was conducted.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria GonzalezTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
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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