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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627366
Report Date: 09/26/2019
Date Signed: 09/26/2019 12:56:18 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:GARCIA, BRENDA FAMILY CHILD CAREFACILITY NUMBER:
376627366
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
09/26/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Brenda Garcia TIME COMPLETED:
08:30 AM
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Licensing Program Analyst (LPA) Jo Ann Legaspi made a collateral inspection in response to an incident which may have occurred at another facility. LPA met with Licensee Brenda Garcia and was granted entry. The purpose of the visit was discussed with Licensee Garcia. Present in the home was the Licensee, two (2) helpers and one (1) daycare child.

LPA interviewed staff and a tour of the facility and grounds. No deficiencies cited during this site inspection.

LPA provided the Licensee with the Notice of Site Visit – LIC 9213, which is to be posted for thirty (30) days. An exit interview was conducted with Licensee Garcia, who was provided a copy of her Licensee Rights (LIC 9058 1/16); her signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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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