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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
372018024
Report Date:
12/05/2023
Date Signed:
12/05/2023 12:12:30 PM
Document Has Been Signed on
12/05/2023 12:12 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:
GORDON, BOBBIE FAMILY CHILD CARE
FACILITY NUMBER:
372018024
ADMINISTRATOR:
BOBBIE GORDON
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(760) 789-9732
CITY:
RAMONA
STATE:
CA
ZIP CODE:
92065
CAPACITY:
14
CENSUS:
5
DATE:
12/05/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:45 AM
MET WITH:
Bobbie Gordon
TIME COMPLETED:
12:30 PM
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LPA Patrick Ma made unannounced visit on 12/5/23 for the purpose to amend reports dated 8/8/23 and 10/13/23.
SUPERVISOR'S NAME:
Renesha Askew
TELEPHONE:
(619) 767-2155
LICENSING EVALUATOR NAME:
Patrick Ma
TELEPHONE:
(619) 767-2218
LICENSING EVALUATOR SIGNATURE:
DATE:
12/05/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/05/2023
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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