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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626543
Report Date: 10/10/2019
Date Signed: 10/10/2019 03:32:47 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:PORTUGAL, MARIVEL & PARRA, OCTAVIO FCCHFACILITY NUMBER:
376626543
ADMINISTRATOR:M. PORTUGAL & O. PARRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 642-4743
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:14CENSUS: DATE:
10/10/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Marivel PortugalTIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPA) Samantha Salunga and Gloria Gonzalez completed an unannounced case management inspection for the purpose of delivering an amended report from an original report dated, 07/19/2019. Upon arrival LPA's met with Co-Licensee, Marivel Portugal. LPA Gonzalez acted as Spanish translator during time of inspection. Also present were 2 children.

No deficiencies observed in the areas inspected during today's inspection. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA's observed Licensee post notice of site visit.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
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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