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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376612193
Report Date: 02/18/2021
Date Signed: 02/18/2021 01:34:24 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:GOMEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
376612193
ADMINISTRATOR:GOMEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 744-8409
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY:14CENSUS: 12DATE:
02/18/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee Maria "Dolly" GomezTIME COMPLETED:
01:25 PM
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On 2/1/2021 @ 4:00 p.m. Licensing Program Analysts, Joelle Redding and LeAndra Dolliole, made a virtual case management insepction, via FaceTime, due to Covid-19 restrictions. The purpose of this visit is to revisit and review Department of Public Health Guidelines regarding Covid-19.

Licensee completed a self assessment guide which was reviewed during this visit. The facility was toured to ensure adequate social distancing and appropriate use of PPE. Sufficent and up to date resources are on hand. Covid-19-related safety and informational posters are visibly posted for parents, children and staff. Facility staff, parents and children are routinely reminded of proper procedures to ensure safety.

This report will be delivered via email due to Covid-19 restrictions. Facility's reply to this email is considered signature and confirmation of receipt.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2021
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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