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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
136610333
Report Date:
07/20/2021
Date Signed:
07/20/2021 11:48:08 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:
GONZALEZ, SANDRA FAMILY CHILD CARE
FACILITY NUMBER:
136610333
ADMINISTRATOR:
SANDRA GONZALEZ
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(760) 768-9530
CITY:
CALEXICO
STATE:
CA
ZIP CODE:
92231
CAPACITY:
14
CENSUS:
12
DATE:
07/20/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:19 AM
MET WITH:
Sandra Gonzalez
TIME COMPLETED:
11:55 AM
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On 7/20/21 at 11:19am Licensing Program Analyst (LPA) Gloria Gonzalez and Licensing Program Manager (LPM) Tulam Vu conducted an unnanounced case management to interview a daycare child unrelated to this facility.
This report was translated in Spanish by LPA.
SUPERVISOR'S NAME:
Tulam Vu
TELEPHONE:
(619) 767-2212
LICENSING EVALUATOR NAME:
Gloria Gonzalez
TELEPHONE:
(619) 767-2238
LICENSING EVALUATOR SIGNATURE:
DATE:
07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/20/2021
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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