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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376619016
Report Date: 06/17/2021
Date Signed: 06/17/2021 12:38:16 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:CASTRO, MARIA FAMILY CHILD CAREFACILITY NUMBER:
376619016
ADMINISTRATOR:MARIA CASTROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 282-8943
CITY:SAN DIEGOSTATE: CAZIP CODE:
92104
CAPACITY:14CENSUS: DATE:
06/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maria CastroTIME COMPLETED:
12:45 PM
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On 06/17/2021 PM AM Licensing Program Analyst (LPA) Dana Stevens, conducted an unannounced case management inspection to amend complaint investigation report dated 05/25/2021. LPA informed Licensee of the purpose of the inspection.

There are no deficiencies cited. An exit interview was conducted with Maria Castro and a copy of this report was left with the provider.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
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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