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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625439
Report Date: 11/20/2019
Date Signed: 11/20/2019 03:54:33 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:DELGADO, ALICIA & JOSE FAMILY CHILD CAREFACILITY NUMBER:
376625439
ADMINISTRATOR:ALICIA & JOSE DELGADOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 741-4788
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:14CENSUS: 10DATE:
11/20/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:37 PM
MET WITH:Alicia & Jose DelgadoTIME COMPLETED:
04:10 PM
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Licensing Program analyst (LPA), Rajani Goudreau made an unannounced Plan of Correction (POC) visit for the purpose of ensuring deficiency cited on 11/13/19 under section 102417(g)(5)(A) has been cleared. Upon arrival, LPA met with licensees, Alicia & Jose Delgado and proceeded to tour the home. LPA verified home was within proper ratio/capacity limitations.

LPA observed pool gate to be self-closing, self-latching and swing away from the pool. In addition, self-latching device is no more than six inches from the top of gate, per LPA observation. Licensee currently has a key holder clip on pool gate as an extra prevention measure. LPA discussed with licensees the importance of ensuring the pool gate meets licensing regulations. Licensees acknowledges understanding of the requirements. LPA provided licensees with the pool gate licensing requirements under section 102417(g)(5)(A) for future reference. Deficiency cleared during today’s visit. LPA provided licensees with cleared Plan of Correction letter.

No deficiencies cited during today’s visit. LPA conducted an exit interview with licensees. LPA provided licensees with the following: LIC809, LIC9213-Notice of Site Visit. LPA informed licensees LIC9213 must be posted for 30 days from today’s date. LPA observed licensee post LIC9213 prior to exiting facility.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019
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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