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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100964
Report Date: 07/18/2024
Date Signed: 07/18/2024 02:41:14 PM

Document Has Been Signed on 07/18/2024 02:41 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:BAUTISTA, TERESA FAMILY CHILD CAREFACILITY NUMBER:
376100964
ADMINISTRATOR/
DIRECTOR:		TERESA BAUTISTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 829-4202
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
07/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:01 PM
MET WITH:Teresa BautistaTIME VISIT/
INSPECTION COMPLETED:
02:55 PM
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On 7/18/2024 @ 2:01PM, Licensing Program Analysts (LPAs) Nancy Diaz and Stefanie Mutialu conducted an unannounced case management inspection. LPAs met and toured the home with Mrs. Bautista. Observed present today were 4 children (2 of the children were under age 2).

The purpose of this inspection is to deliver an amended LIC 809D that was written and delivered on August 31, 2023.

There were no deficiencies observed today.

Exit interview was conducted with Mrs. Bautista. LPA reviewed and provided a copy of this report with Mrs. Bautista. Notice of site visit was given and must be posted for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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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