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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370816377
Report Date: 06/08/2022
Date Signed: 06/08/2022 12:23:29 PM


Document Has Been Signed on 06/08/2022 12:23 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:ROJO, CLELY FAMILY DAY CAREFACILITY NUMBER:
370816377
ADMINISTRATOR:ROJO, CLELYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 500-5915
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:14CENSUS: 0DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Clecy RojoTIME COMPLETED:
12:20 PM
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On 6/8/22 at 11:30am, LPA Adrian Castellon arrived at the facility to conduct a Required 1 year unannounced inspection. LPA Castellon met with licensee Clecy Rojo and her husband Daniel Rojo. Licensee Rojas states that she is not currently providing care for when a license is required. She states that she has not provided care for the past six months and.states that she contacted CDA to advise of her intentions to place the license on INACTIVE STATUS. LPA Castellon entered the home to ensure that no daycare children were present. On this date, LPA Castellon discussed the INACTIVE STATUS process with licensee Rojas and her husband. Licensee Rojas wishes to place her license on INACTIVE STATUS. Licensee signed and dated the LIC9211 on this date. Licensee understands that while the license is on INACTIVE STATUS:

will not provide child care for which a license is required until license is reactivated.
b. I will continue to promptly pay the annual license fee.
c. I will inform your office of any changes in the above dates prior to
re-opening my facility by submitting a new LIC 9211.
d. I will be in compliance with all licensing laws and regulations upon
re-opening my facility, including but not limited to:
● Ensuring all adult staff and residents, including children who turn 18
during the inactive period, have criminal record clearances
● Maintaining current CPR and First Aid cer tifications
● Maintaining a current fire extinguisher and functioning smoke alarms
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022
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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