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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627090
Report Date: 10/05/2021
Date Signed: 10/05/2021 12:26:25 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:POLUS, RITA FAMILY CHILD CAREFACILITY NUMBER:
376627090
ADMINISTRATOR:RITA POLUSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 715-7898
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:14CENSUS: 0DATE:
10/05/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Rita PolusTIME COMPLETED:
12:40 PM
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On 10/5/2121 at 11:30 AM Licensing Program Analyst (LPA) Adrian Mangina conducted a Plan of Correction visit to the child care home to follow-up on deficiency cited during annual inspection on 9/21/21. There were no children in care at the time of the visit. Also present in the home were Licensee's husband Carlo Marrogi and Ruwaida Yalda who provided translation. Proper supervision and ratios were observed.

During the visit LPA verified that:

1) Licensee has current roster of children
2) Licensee has provided Consent for Emergency Treatment for all children in care

No deficiencies were cited during this visit.

Licensee was provided with a copy of this report (LIC809) and Appeal Rights (LIC9058). Their signature on this form is an acknowledgement of receipt. A Notice of Site Visit (LIC9213)was also provided and must be posted for 30 consecutive days.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
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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