<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376621538
Report Date: 02/28/2025
Date Signed: 02/28/2025 11:22:26 AM

Document Has Been Signed on 02/28/2025 11:22 AM - 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 CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SERENA, MARISELA FAMILY CHILD CAREFACILITY NUMBER:
376621538
ADMINISTRATOR/
DIRECTOR:		MARISELA SERENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 421-3689
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
02/28/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Marisela SerenaTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/28/2025 at 8:35AM, Licensing Program Analyst (LPA) Saul Zazueta conducted an unannounced Annual inspection with Licensee, Marisela Serena. LPA disclosed the purpose of the inspection and was led on a tour of the facility, both indoors and outdoors. This facility is a two-story, four (4) bedroom, three (3) bathroom house. The following areas are used for childcare: living room, dining room, breakfast nook, kitchen, daycare room and bathroom #1. Off limits areas include garage and entire second floor consisting of four (4) bedrooms, and two (2) bathrooms. Off limits areas are inaccessible to children by use of safety gates and door locks. LPA observed the stairs to have no safety gate installed while children under 5 years old were present. Days and hours of operation are Monday through Friday, 6:00AM to 6:00PM. There was two (2) children present during the inspection.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements and were observed to be operational. LPA informed licensee that poisons, detergents, cleaning compounds, medications and other hazardous items shall be placed in a storage area and locked. LPA observed a drawer in the kitchen to contain knives, which were not made inaccessible to children in care. LPA also observed poison stored on a shelf in the garage that was not locked. Backyard is used for outdoor activities. LPA informed licensee to ensure that children are supervised at all times during outdoor activities. There is no fireplace in the home. Licensee stated that there are no pools or bodies of water on the premises, which was confirmed by LPA during inspection. Licensee has children's toys, play equipment and books available. Licensee has a working cell phone. Licensee stated that there are no firearms, other weapons, or ammunition in the home.

A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. LPA reviewed children’s files and observed them to be incomplete. Out of two (2) children in care, Child #1 was missing the LIC995 and LIC9150, and Child #2 was missing the LIC267 and LIC9150. LPA observed copies of children immunization in both files, but no CDPH286. Licensee also stated that they perform routine checks on sleeping infants during nap time, but that they do not document the times.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Saul Zazueta
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 9
Document Has Been Signed on 02/28/2025 11:22 AM - It Cannot Be Edited


Created By: Saul Zazueta On 02/28/2025 at 09:34 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SERENA, MARISELA FAMILY CHILD CARE
FACILITY NUMBER: 376621538

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(3)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in that the stairs were not fenced or barricaded where children less than five years old are in care, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2025
Plan of Correction
1
2
3
4
Licensee stated that they will temporarily barricade the stairs with a safety gate, while they consult a specialist to erect a more permanent solution. Licensee stated that they will provide proof of permanent barricade to the San Diego Regional Office (SDRO) by 3/31/2025.
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in that knives were found in a drawer located in the kitchen that is accessible to children, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2025
Plan of Correction
1
2
3
4
Licensee stated that they will move knives to a different drawer and install a security latch, making the knives innaccessible. Licensee stated that they will provide proof of secured knives to the San Diego Regional Office (SDRO) by 3/31/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jason Garay
LICENSING EVALUATOR NAME:Saul Zazueta
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2025


LIC809 (FAS) - (06/04)
Page: 2 of 9
Document Has Been Signed on 02/28/2025 11:22 AM - It Cannot Be Edited


Created By: Saul Zazueta On 02/28/2025 at 09:34 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SERENA, MARISELA FAMILY CHILD CARE
FACILITY NUMBER: 376621538

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in that Raid bug spray and Termite killer were found on a shelf in the garage without a lock, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2025
Plan of Correction
1
2
3
4
Licensee stated that they would install doors on the shelf and ensure that they remain locked. Licensee stated that they will provide proof of secured poisons with a lock to the San Diego Regional Office (SDRO) by 3/31/2025.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jason Garay
LICENSING EVALUATOR NAME:Saul Zazueta
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2025


LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 02/28/2025 11:22 AM - It Cannot Be Edited


Created By: Saul Zazueta On 02/28/2025 at 09:34 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SERENA, MARISELA FAMILY CHILD CARE
FACILITY NUMBER: 376621538

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in that there was no fire disaster drill log, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2025
Plan of Correction
1
2
3
4
Licensee stated that they conduct fire drills every 6 months, but that due to moving things around, the log was misplaced. Licensee stated that they will conduct a new fire drill and record it on a new log, and present a copy of it to the SDRO by 03/31/2025.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jason Garay
LICENSING EVALUATOR NAME:Saul Zazueta
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2025


LIC809 (FAS) - (06/04)
Page: 4 of 9
Document Has Been Signed on 02/28/2025 11:22 AM - It Cannot Be Edited


Created By: Saul Zazueta On 02/28/2025 at 09:34 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SERENA, MARISELA FAMILY CHILD CARE
FACILITY NUMBER: 376621538

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that Child #1's naps were not recorded on a sleep log, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2025
Plan of Correction
1
2
3
4
Licensee stated that they will keep a written account of every 15 minute check, performed on napping infants, on a sleep log and submit proof to the SDRO by 03/31/2025.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in that they did not have a mandated reporter certificate on file for themselves or assistant, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2025
Plan of Correction
1
2
3
4
Licensee stated that they and their assistant will take the mandated reporter training and provide proof to the SDRO by 03/31/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jason Garay
LICENSING EVALUATOR NAME:Saul Zazueta
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2025


LIC809 (FAS) - (06/04)
Page: 5 of 9
Document Has Been Signed on 02/28/2025 11:22 AM - It Cannot Be Edited


Created By: Saul Zazueta On 02/28/2025 at 09:34 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SERENA, MARISELA FAMILY CHILD CARE
FACILITY NUMBER: 376621538

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in that two (2) out of two (2) children in care had required documents missing from their files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2025
Plan of Correction
1
2
3
4
Licensee stated that they will obtain signed copies of LIC995 and LIC9150 for Child #1, and the LIC267 and LIC9150 for Child #2. Also, Licensee stated that they will complete the CDPH 286 for both children, and provide proof the the SDRO by 03/31/2025.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in that there was no child roster kept on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2025
Plan of Correction
1
2
3
4
Licensee stated that they will complete a child roster and submit proof to the SDRO by 03/31/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jason Garay
LICENSING EVALUATOR NAME:Saul Zazueta
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2025


LIC809 (FAS) - (06/04)
Page: 6 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SERENA, MARISELA FAMILY CHILD CARE
FACILITY NUMBER: 376621538
VISIT DATE: 02/28/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Licensee did not have a current Mandated Reporter AB1207 training for themselves or assistant. Pediatric CPR and First Aid certification expires on 5/18/2025. Licensee has required immunizations, per file review. Required documents were posted during the time of inspection. Licensee did not maintain a facility roster. The licensee stated that they conducted and documented a fire and disaster drill four months ago, but could not locate the log. There is one crib or play yard for each infant who is unable to climb out of the crib or play yard.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA reviewed with Licensee the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the Licensee.

LPA discussed safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Saul Zazueta
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025
LIC809 (FAS) - (06/04)
Page: 7 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SERENA, MARISELA FAMILY CHILD CARE
FACILITY NUMBER: 376621538
VISIT DATE: 02/28/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Licensee was informed the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care. LPA reviewed with licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

On this date, 02/28/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ. LPA discussed California Megan's Law with licensee and provided: www.meganslaw.ca.gov.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Saul Zazueta
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025
LIC809 (FAS) - (06/04)
Page: 8 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SERENA, MARISELA FAMILY CHILD CARE
FACILITY NUMBER: 376621538
VISIT DATE: 02/28/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Per California Code of Regulations, (Title 22, division 12 & Chapter 3), eight (8) Type B citations are being cited on the attached LIC 809-D.

A notice of site visit was given and must remain posted for 30 days.

During the exit interview, the Licensee, Marisela Serena, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

An exit interview was conducted, and this report was reviewed with Licensee, Marisela Serena.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Saul Zazueta
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025
LIC809 (FAS) - (06/04)
Page: 9 of 9