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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376619543
Report Date: 11/17/2021
Date Signed: 11/17/2021 10:02:51 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:NEVAREZ, LOURDES & EDUARDO FAMILY CHILD CAREFACILITY NUMBER:
376619543
ADMINISTRATOR:LOURDES & EDUARDO N.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 562-0509
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:14CENSUS: 1DATE:
11/17/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Lourdes & Eduardo NevarezTIME COMPLETED:
09:40 AM
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On 11/17/21 @ 9:20AM, Licensing Program Analyst (LPA) Nancy Diaz conducted an unannounced inspection. The purpose of this inspection is to observed corrections to deficiencies cited on 11/12/21. Mr. & Mrs. Nevarez were home today providing care to 1 child.

The following corrections were observed:
- Mr. Nevarez removed the nails that were sticking out.
- Outlets were observed covered.
- The broken tile at the bottom of the stairs was covered.

No further deficiency cited today.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021
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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