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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610655
Report Date: 05/03/2024
Date Signed: 05/03/2024 03:24:45 PM

Document Has Been Signed on 05/03/2024 03:24 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:TREVINO, JOCELINE FAMILY CHILD CAREFACILITY NUMBER:
136610655
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
05/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Joceline TrevinoTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 05/03/2024 LPA Dana Stevens conducted an Unannounced Case Management visit for the purpose of follow up on an Unusual Incident that occurred on 02/16/2024. LPA was met by Licensee Joceline Trevino and LPA informed her of the reason for the visit.

An unusual incident occurred on 02/16/2024 around 3:00 PM. Licensee called Emergency Services for a medical emergency involving a minor family member. The minor was staying temporarily in the home in an off-limits room.
There was one daycare child present at the time of the incident. Licensee reported the incident to Licensing on 02/20/2024.

LPA interviewed Licensee, and household members and collected facility records.

Further investigation is needed. No deficiencies cited.

Exit interview conducted and copy of this report was provided to Licensee.
Notice of site visit must be posted for 30 days.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
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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