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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610539
Report Date: 10/15/2021
Date Signed: 10/15/2021 08:53:52 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:CRUZ, LETICIA FAMILY CHILD CAREFACILITY NUMBER:
136610539
ADMINISTRATOR:LETICIA CRUZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 562-6164
CITY:CALEXICOSTATE: CAZIP CODE:
92231
CAPACITY:14CENSUS: 4DATE:
10/15/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Leticia CruzTIME COMPLETED:
09:00 AM
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On 10/15/2021 at 8:20 am, Licensing Program Analysts (LPAs), Gloria Gonzalez conducted an unannounced Plan of Correction (POC) inspection at the facility. Purpose of this inspection is to ensure citations issued during an annual inspection dated 9/9/2021 and 9/17/21 were corrected. Upon arrival, LPA met with Licensee, Leticia Cruz and proceeded to tour the facility.

There were four (4) children, including two (2) infants and Licensee and Licensee's husband, Jose Navarrete during today’s inspection. LPA observed capacity to be within the limitations set forth on the license.

The following citation issued on 9/9/21 was corrected as follows:

Licensee provided a copy of the tuberculosis test results showing as negative on this date for Adult #1.

The pool gate that was not self-latching was corrected by the plan of correction date of 9/15/21. Licensee sent Licensing a video of the pool gate self closing and self latching. At today's inspection LPA observed the pool gate self closing and self latching.

Licensee submitted video to Licensing of the pool house located behind the pool to Licensing on 9/19/21. On this date LPA observed the pool house to be livable space and is made inaccessible to children by the use of the pool gate.

LPA provided Licensee, Leticia Cruz with the Notice of Site Visit – LIC 9213, which is to be posted for thirty (30) days. LPA observed form LIC 9213 posted on the bulletin board at the entrance. An exit interview was conducted with the licensee, who was provided a copy of their Licensee Appeal Rights (LIC 9058 1/16).
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria GonzalezTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
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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