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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629187
Report Date: 11/23/2021
Date Signed: 11/23/2021 09:23:32 AM

Document Has Been Signed on 11/23/2021 09:23 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:LEOS VALDIVIA, MARGARITA FAMILY CHILD CAREFACILITY NUMBER:
376629187
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Margarita Leos Valdivia, ProviderTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) D. Sanchez made an unannounced Case Management inspection to amend Prelicensing report dated 11/10/2021. During today's inspection, provider Margarita advised LPA that she would like to open bedroom #2 for daycare purposes. LPA inspected bedroom #2 and approved the room for daycare purposes.

Daycare areas will include: living room, dining room, kitchen, bedroom #2&3, hallway bathroom and back yard. Off limits areas includes: Master bedroom #1 and garage.

No deficiencies were cited during today's inspection. An exit interview was conducted with Margarita Leos Valdivia and a copy of this report left at the facility.

LPA observed provider placing the Notice of Cite Visit on the wall visible to parents during today’s inspection.

NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/23/2021
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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