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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376614893
Report Date: 09/04/2019
Date Signed: 09/04/2019 11:25:44 AM

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:VAZQUEZ, PATRICIA FAMILY CHILD CAREFACILITY NUMBER:
376614893
ADMINISTRATOR:PATRICIA VAZQUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 584-2246
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY:14CENSUS: 5DATE:
09/04/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Patricia VazquezTIME COMPLETED:
11:30 AM
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LPA, Luigi Gargaro, conducted an unannounced case management visit to the facility today to follow up on documentation related to the licensee's ongoing facility monitoring plan. Analyst obtained form to be returned for facility file and had licensee sign today's visit report and left a copy for her records.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi GargaroTELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019
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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