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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376628435
Report Date:
08/29/2019
Date Signed:
08/29/2019 05:51:13 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:
MENDOZA, JENNIFER & GRACIELA FAMILY CHILD CARE
FACILITY NUMBER:
376628435
ADMINISTRATOR:
A
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(619) 207-0161
CITY:
IMPERIAL BEACH
STATE:
CA
ZIP CODE:
91932
CAPACITY:
14
CENSUS:
DATE:
08/29/2019
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
04:10 PM
MET WITH:
Graciela Mendoza
TIME COMPLETED:
05:30 PM
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LPA Adrian Castellon conducted a case management inspection on this date. LPA Castellon met with licensee Jennifer Mendoza & Graciela Mendoza and discussed the purpose of the inspection. The purpose of the inspection is to inspect the facility as licensee Mendoza submitted a change of location. Licensee currently has a large license. Licensee has recently moved to a new location.
MVCCRO received a fire clearance from IBFD dated 08.29.19.
A large license will be issued.
SUPERVISOR'S NAME:
Jason Garay
TELEPHONE:
(619) 767-2250
LICENSING EVALUATOR NAME:
Adrian Castellon
TELEPHONE:
(619) 767-2237
LICENSING EVALUATOR SIGNATURE:
DATE:
08/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/29/2019
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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