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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376622338
Report Date: 11/18/2022
Date Signed: 11/18/2022 11:22:29 AM

Document Has Been Signed on 11/18/2022 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:FORBES, YVONNE FAMILY CHILD CAREFACILITY NUMBER:
376622338
ADMINISTRATOR:YVONNE FORBESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 422-1328
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
11/18/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Yvonne ForbesTIME COMPLETED:
11:15 AM
NARRATIVE
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On November 18, 2022 at 9:45 am , Licensing Program Analyst (LPA), Edgar Campana conducted an unannounced Case Management POC Inspection and met with the Licensee, Yvonne Forbes.  LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee.  Four (4) children and one (1) staff were present in the facility during this inspection.

Licensee informed LPA that a properly fitting barricade could not be obtained by POC due date. LPA informed Licensee that an extension until 11/21/2022 is granted.

Also, LPA E. Campana also delivered a copy of amended reports originally created on 11/16/2022.

No deficiencies cited.

Exit interview conducted in Spanish and report was reviewed with Licensee, Yvette Forbes. A copy of this report was provided to Licensee.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2022
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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