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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376620000
Report Date: 09/23/2022
Date Signed: 09/23/2022 01:05:17 PM

Document Has Been Signed on 09/23/2022 01:05 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:CRUZ, GUADALUPE & GONZALEZ, MATILDE FCCFACILITY NUMBER:
376620000
ADMINISTRATOR:GUADALUPE C. & MATILDE G.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 249-0539
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
09/23/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Licensees, Guadalupe Cruz and Matilde GonzalezTIME COMPLETED:
01:15 PM
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On 9/23/22 at approximately 11:58am, an unannounced Plan of Correction inspection was conducted by Licensing Program Analyst (LPA) Saraliz Velando. LPA met with licensees, Guadalupe Cruz and Matilde Gonzalez. LPA also observed 10 children.

The purpose of this inspection was in reference to deficiencies cited on 7/29/22.

The following corrections needed to be cleared:
- Section 1596.8662(b)(1) - Licensees will complete Mandated Reporter Training.
- Section 102417(g) – Backyard has several furrows creating a tripping hazard.
- Section 102417(g)(8) – No child roster.

The following deficiency needed to be corrected:
- Section 102421 - 9 out 10 children’s files were not complete.

The children’s files were reviewed and found to be complete and meet regulations. Mandated Reporter Training expires August 2024. The furrows in backyard have been filled with dirt and leveled for safety of the children. Roster has been created and copy given to LPA. POC Clearance Letters were given to licensees. No deficiencies were cited today.

Licensees were provided a copy of this report.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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