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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100964
Report Date: 01/31/2022
Date Signed: 01/31/2022 02:26:34 PM

Document Has Been Signed on 01/31/2022 02:26 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:BAUTISTA, TERESA FAMILY CHILD CAREFACILITY NUMBER:
376100964
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
01/31/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Teresa BautistaTIME COMPLETED:
02:35 PM
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On 1/31/22 at 1:00pm Licensing Program Analysts (LPAs) Annette Sutherland and Selina Siao conducted a pre- licensing follow-up inspection. LPAs met with Teresa Bautista , also present was one infant day care child. The purpose of today's inspection is to ensure the pool fencing meets the department requirements. Applicant has extended the fencing to be over 5 feet high. There is a self latching door that swings away from the pool but the latch is too low and does not meet the department's requirement.

The home also has a window that has access to the pool and there is sufficient space to place a fence therefore Applicant was advised that she needs to extend her fence to block off the window. LPAs consulted with the Regional Manager Kimberly Hall during today's inspection. A follow up visit will be needed when applicant corrected the required requirements.

Applicant shall submit photos of corrections to LPA Annette Sutherland within 30 days no later than 2/28/2022.



SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022
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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