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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625439
Report Date: 11/25/2020
Date Signed: 11/25/2020 12:32:57 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: 4DATE:
11/25/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Jose Delgado TIME COMPLETED:
10:38 AM
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On November 25, 2020 at 10:15 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management inspection regarding Provider Information Notice (PIN) 20-24-CCP/ Safe Sleep and PIN 20-27-CCLD/Coronavirus Disease 2019 Infection Control for Celebration and Outings. LPA advised Licensee of the meeting’s purpose. Due to the COVID 19 outbreak, this inspection was done as a tele visit via the FaceTime platform. Present in the daycare was one (1) daycare infant, two (2) daycare toddlers, and one (1) daycare school aged child, and the Licensees.

LPA electronically provided Licensee with PIN 20-24-CCP, LIC 9227 and PIN 20-27-CCLD. Licensee and LPA reviewed PIN 20-24-CCP and a blank copy of form LIC 9227 Individual Infant Sleeping Plan. Licensee agreed to begin to use the LIC 9227. Licensee and LPA reviewed PIN 20-27-CCLD. Licensee agreed to post this PIN in an area where it is visible to all individuals and where it can be easily accessible.

A Notice of Site Visit (LIC 9213) is to be posted for thirty (30) days. LPA electronically provided this document to Licensee Jose Delgado. An exit interview was conducted. A copy of this report and Licensee/Appeal Rights (LIC 9058) will be e-mailed to the Licensee. The Licensee was advised that acknowledgement of the receipt of the report is to be received within twenty-four hours.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2020
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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