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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610333
Report Date: 07/07/2022
Date Signed: 07/07/2022 12:51:35 PM


Document Has Been Signed on 07/07/2022 12:51 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:GONZALEZ, SANDRA FAMILY CHILD CAREFACILITY NUMBER:
136610333
ADMINISTRATOR:SANDRA GONZALEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 768-9530
CITY:CALEXICOSTATE: CAZIP CODE:
92231
CAPACITY:14CENSUS: 10DATE:
07/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Sandra GonzalezTIME COMPLETED:
01:00 PM
NARRATIVE
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On July 7, 2022 at 12:00 pm, Licensing Program Analyst (LPA) Gloria Gonzalez conducted an unannounced case management inspection to amend the complaint investigation report issued on 06/16/2022. LPA advised Licensee, Sandra Gonzalez of the inspection’s purpose and Licensee granted LPA facility entry. Present in the home was the Licensee, one (1) staff member, and 10 day care children(3 infants, 3 toddlers, and 4 school age).

A copy of the report and appeal rights (LIC 9058) was provided to the applicant and notice of site visit (LIC9213) was given to Licensee and advised it must remain posted for 30 days.

LPA interpreted and explained the inspection report to licensee in Spanish, licensee stated she understood.

An exit interview conducted and report was reviewed with the licensee, Sandra Gonzalez.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria GonzalezTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022
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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