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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372018024
Report Date: 11/21/2023
Date Signed: 11/21/2023 09:40:20 AM


Document Has Been Signed on 11/21/2023 09:40 AM - 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:GORDON, BOBBIE FAMILY CHILD CAREFACILITY NUMBER:
372018024
ADMINISTRATOR:BOBBIE GORDONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 789-9732
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY:14CENSUS: 6DATE:
11/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Bobbie GordonTIME COMPLETED:
10:00 AM
NARRATIVE
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On 11/21/23, LPA Patrick Ma was present at the facility for a different reason. During this visit LPA interviewed licensee.

Based on the information obtained during interviews, Licensee has periodically used a room that was not licensed for child care.

See 809D for deficiency cited.

During visit, Licensee asked to add room #3 (son's room) to license. Room was inspected and approved for license.

Exit interview conducted and report was reviewed with the licensee Bobby Gordon. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick MaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 11/21/2023 09:40 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: GORDON, BOBBIE FAMILY CHILD CARE
FACILITY NUMBER: 372018024

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2023
Section Cited
CCR
102416.3(a)(6)

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Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department…Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
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Licensee requested to add bedroom #3 (son's room). Room was added, deficiency cleared during visit.
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Based on the information obtained during interviews, Licensee has periodically used a room for children in care that was not licensed for child care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick MaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2