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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376614893
Report Date: 08/27/2019
Date Signed: 08/27/2019 04:07:19 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: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: 6DATE:
08/27/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Patricia VazquezTIME COMPLETED:
04:10 PM
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LPA, Luigi Gargaro, conducted a case management visit to the facility today to deliver and amended civil penalty that was issued during a 06/11/19 visit. Analyst provided the license with the amended Civil Penalty Assessment form (LIC421B) and advised that it would serve as a replacement for the previously issued form. Analyst obtained the original copy of the civil penalty previously issued to the licensee during his visit.

During the visit, analyst also provided licensee with a case closure notice for former assistant Cindy Orozco. Licensee was given an Addendum To Notification Of Parents' Rights form (LIC 995) to have parents sign acknowledging that the former employee can no longer be present in the home.

Licensee was provided with a copy of the amended civil penalty, the parent notification addendum and a copy of today's report before analyst left the home.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi GargaroTELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019
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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