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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629370
Report Date: 06/20/2023
Date Signed: 06/20/2023 05:12:58 PM

Document Has Been Signed on 06/20/2023 05:12 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:RODRIGUEZ, EDITH FAMILY CHILD CAREFACILITY NUMBER:
376629370
ADMINISTRATOR:EDITH RODRIGUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 799-3318
CITY:SAN DIEGOSTATE: CAZIP CODE:
92113
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
06/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Edith RodriguezTIME COMPLETED:
02:25 PM
NARRATIVE
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On 6/20/23 at 2:10 p.m., Licensing Program Analyst (LPA), Cindy Meier conducted an unannounced case management inspection in order to deliver an amended report originally created on 03/27/23. Upon arrival LPA met with the licensee, Edith Rodriguez and explained the purpose of the visit. There were five (5) children present during the visit.

No deficiencies cited.

Exit interview was conducted with the licensee, Edith Rodriguez. Notice of Site Visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2023
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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