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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629066
Report Date: 02/23/2021
Date Signed: 02/23/2021 12:55:43 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:GASTELUM, LAURA FAMILY CHILD CAREFACILITY NUMBER:
376629066
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
02/23/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Laura Gastelum TIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Casey Gulley and LPA Gloria Gonzalez conducted an announced on-site prelicensing inspection. Purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This two story, four bedroom, three bath house bottom level and top level was toured and inspected.

Applicant will use the following areas for child care: living room, daycare bathroom, kitchen, dining room and back yard. Off limits areas include: three(3) bedrooms, two baths located upstairs. They are made inaccessible to day care children through the use of door locks, doorknob covers, and a safety gate.

Applicant maintains documentation of proof of control of property for review by the Department. Required documents are posted. LPA Casey Gulley confirmed adults living in the home. Applicant was advised that any new/additional adults must be cleared prior to working or residing in home.

A copy of the report will be e-mailed to applicant and acknowledgement of the receipt of the report is to be received within twenty-four hours.

No corrections are needed. A small license is issued effective on 02/24/2021.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2021
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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