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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629117
Report Date: 10/13/2021
Date Signed: 01/10/2023 02:59:08 PM

Document Has Been Signed on 01/10/2023 02:59 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:VELAZQUEZ, GABRIELA FAMILY CHILD CAREFACILITY NUMBER:
376629117
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
10/13/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Gabriela VelazquezTIME COMPLETED:
04:30 PM
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On 10/13/21 at 4:00pm, Licensing Program Analyst (LPA) Adrian Castellon conducted an announced capacity increase inspection with licensee Gabriela Velazquez. Purpose of the visit is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3 and so that a large license capacity 14 may be issued A fire clearance report dated 10/12/21 was received by the SDRO. This 3 bedroom, 2 bath home was toured and inspected to ensure an environment safe for the care and supervision of children. Licensee is renting the home. Licensee Velazquez will use the following areas for child care: living room, daycare room (bedroom #3) and daycare bathroom. Off limits areas include: bedrooms #1 and #2, kitchen and hallway bathroom. Licensee will utilize the fully fenced back yard for outdoor activities. There are no bodies of water observed during time of visit. Licensee states that there are no firearms in the home. The fire extinguisher, carbon monoxide detector and smoke detector meet requirements and are operational.

A large license will be issued after a final file review. No citations issued on this date.

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2021
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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