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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376614616
Report Date: 05/15/2023
Date Signed: 05/15/2023 02:36:34 PM


Document Has Been Signed on 05/15/2023 02:36 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:HULS, SILVIA FAMILY CHILD CAREFACILITY NUMBER:
376614616
ADMINISTRATOR:SILVIA HULSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 417-0964
CITY:SAN DIEGOSTATE: CAZIP CODE:
92124
CAPACITY:14CENSUS: 0DATE:
05/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Silvia HulsTIME COMPLETED:
02:45 PM
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On 5/15/23 at 2:25 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced case management inspection at the facility. The purpose of the visit was to follow up on a reported infant death that occurred at the facility and provide grief resources to the Licensee. Upon arrival, LPA met with Licensee Silvia Huls and toured the facility. There were no children in care. Licensee decided to close for the week.

During the visit, LPA provided grief resources. Licensee stated she would send roster and other documents requested by LPA at a later time.

No deficiencies were cited at this inspection.

Exit interview conducted and report was reviewed with Licensee, Silvia Huls. Notice of site visit was provided and must be posted for 30 days.

SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2023
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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