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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376618348
Report Date: 02/16/2023
Date Signed: 02/16/2023 02:08:39 PM

Document Has Been Signed on 02/16/2023 02:08 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:WILLIAMS, LACY FAMILY CHILD CAREFACILITY NUMBER:
376618348
ADMINISTRATOR:LACY WILLIAMSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 269-8331
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
02/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Lacy Williams, LicenseeTIME COMPLETED:
02:15 PM
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On 02/16/2023 at 1:45 pm, Licensing Program Analyst (LPA), Michelle Hood made an unannounced inspection for the purpose to deliver an amended report. LPA met with the licensee Lacy Williams. During the inspection the LPA observed 5 children in the daycare room. Facility is within ratio and capacity.

An exit interview was conducted and the report was reviewed with the licensee Lacy Williams. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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