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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610449
Report Date: 09/02/2021
Date Signed: 09/02/2021 04:13:08 PM

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:RUIZ, ALMA FAMILY CHILD CAREFACILITY NUMBER:
136610449
ADMINISTRATOR:ALMA RUIZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(442) 225-4442
CITY:CALEXICOSTATE: CAZIP CODE:
92231
CAPACITY:14CENSUS: 4DATE:
09/02/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Alma RuizTIME COMPLETED:
04:20 PM
NARRATIVE
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On September 2, 2021 at 2:30 PM Licensing Program Analyst (LPA) Gloria Gonzalez conducted an unannounced Case Management inspection to follow-up on a self-reported incident of a possible lack of supervision that occurred on or about 8/9/21. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee, Alma Ruiz.  Four (4) children and two (2) staff were present in the facility during this inspection.
 
Interviews were conducted with daycare staff members and a daycare child.

Licensee has already sent LPA the children's roster.

The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.  LPA provided notice of site visit (LIC 9213) and observed it being posted at the facility.

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

An exit interview was conducted with the licensee.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria GonzalezTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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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