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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628105
Report Date: 10/18/2021
Date Signed: 10/18/2021 02:17:54 PM

Document Has Been Signed on 10/18/2021 02:17 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:MEZA, YRMA FAMILY CHILD CAREFACILITY NUMBER:
376628105
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
10/18/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Yrma MezaTIME COMPLETED:
02:31 PM
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On 10/18/2021 at 1:45 pm, Licensing Program Analyst (LPA) Casey Gulley conducted an unannounced Plan of Correction (POC) inspection at the facility. Purpose of this inspection is to ensure citations issued during an annual inspection dated 9/14/21 were corrected. Upon arrival, LPA met with Licensee, Yrma Meza and proceeded to tour the facility.

There were three (3) children and Licensee present during today’s inspection.

No deficiencies observed in the areas inspected during today's inspection. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA reviewed this report with Licensee prior to obtaining her signature.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Casey Gulley
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2021
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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