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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376614941
Report Date: 08/22/2023
Date Signed: 08/22/2023 01:25:22 PM


Document Has Been Signed on 08/22/2023 01:25 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:MIRANDA, BLANCA FAMILY CHILD CAREFACILITY NUMBER:
376614941
ADMINISTRATOR:BLANCA MIRANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 428-3862
CITY:SAN YSIDROSTATE: CAZIP CODE:
92173
CAPACITY:14CENSUS: 3DATE:
08/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Blanca MirandaTIME COMPLETED:
01:45 PM
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This is an amended version of the report that was created on 07/31/2023.

On 8/22/23 1:00 pm, Licensing Program Analyst (LPA) Gloria Gonzalez conducted an unannounced case management inspection to deliver an amended report originally created on 7/31/23. Upon arrival LPA met with Licensee, Blanca Miranda and LPA advised of the purpose of the inspection, and Licensee granted LPA facility entry. Present in the home was the Licensee, one (1) staff member, three (3) day care children.

No deficiencies cited.

LPA interpreted and explained the inspection report to licensee in Spanish, licensee stated she understood.

Exit interview was conducted with Blanca Miranda.  Notice of site visit was given and must remain posted for 30 days.  Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria GonzalezTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2023
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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