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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626355
Report Date: 03/06/2020
Date Signed: 03/06/2020 11:53:05 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:SEXTON, LUZ FAMILY CHILD CAREFACILITY NUMBER:
376626355
ADMINISTRATOR:LUZ SEXTONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 487-1586
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:14CENSUS: 3DATE:
03/06/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Luz Sexton, LicenseeTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA), Michelle Hood made an unannounced case management inspection for the purpose of confirming the removal of Mirna Salcido. At the time of inspection there were three (3) children in care. LPA toured the facility and found no evidence that Mirna Salcido resides or works in the facility. LPA discussed the CBCB- 3 removal documents with licensee. Licensee reviewed and updated the personnel report. Licensee provided LPA with a completed CBCB-3 document.

LPA reviewed this report with licensee and an exit interview was conducted. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit. Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
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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