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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626673
Report Date: 08/21/2019
Date Signed: 08/21/2019 02:47:15 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:LOVERA LOPEZ, JOSUE FAMILY CHILD CAREFACILITY NUMBER:
376626673
ADMINISTRATOR:JOSUE LOVERA LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 941-1921
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:14CENSUS: DATE:
08/21/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:TIME COMPLETED:
02:30 PM
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LPA Armando Locano, completed an unannounced case management site inspection today, met with licensee Josue Lovera Lopez. The purpose of the visit, was for confirming removal of excluded individual, Barreto, Teresa. Licensee has been aware and confirmed to LPA, that adult Teresa Barreto has never been present, working or living in the facility address, since licensee had her fingerprinted, to be a possible employee in the future. Licensee has submitted a signed statement confirming Teresa Barreto has never been in the facility without prior fingerprint approvals, Licensee Josue Lovera Lopez provided LPA A Locano today, a copy of completed and signed statement form # LIC300B titled “ CONFIRMATION OF REMOVEAL FOR: BARRETO, TERESA, form was mailed to licensee by CBCB (Sacramento Caregiver Background Check Bureau). Licensee has mailed copy of completed form to CBCB and copy to LPA today for office file.

Per tour of the home today, LPA A Locano has confirmed that adult Teresa Barreto was not present in the facility. Licensee states that he understands that adult Teresa Barreto does not have cleared fingerprints associated to this facility and is not to be present in the daycare, volunteer, or reside at this address, until such time, that fingerprints should be cleared in the future.

There are no deficiencies cited on this visit, all paperwork was in order, properly posted and the home was properly childproofed.

LPA provided copy of LIC 9213, “Notice of Site Visit,” and observed licensee posting notice during visit.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Armando LocanoTELEPHONE: (619) 767-2221
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
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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