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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628244
Report Date: 06/01/2022
Date Signed: 06/01/2022 12:51:02 PM


Document Has Been Signed on 06/01/2022 12:51 PM - It Cannot Be Edited

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:MONTALVO, MARINA FAMILY CHILD CAREFACILITY NUMBER:
376628244
ADMINISTRATOR:MARINA MONTALVOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 279-4015
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY:14CENSUS: 9DATE:
06/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Cynthia Rodriguez TIME COMPLETED:
12:50 PM
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On 06/01/22 at 11:56 a.m., Licensing Program Analyst (LPA), Rajani Goudreau, conducted an unannounced Case Management inspection in order to deliver an amended report originally created on April 06, 2022. Upon inspection, LPA met with Staff Member, Cynthia Rodriguez and proceeded to tour the facility. During the inspection, there were nine children in care with two staff members present.

No deficiencies issued during today's inspection. An exit interview was conducted with Staff Member, Cynthia Rodriguez. LPA informed the Staff Member Notice of Site visit shall be posted for 30 days from today's date.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022
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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