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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629375
Report Date: 12/12/2023
Date Signed: 12/29/2023 12:29:07 PM

Document Has Been Signed on 12/29/2023 12:29 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HERNANDEZ, GLORIA ZAMAYOA FAMILY CHILD CAREFACILITY NUMBER:
376629375
ADMINISTRATOR:GLORIA ZAMAYOAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 743-9132
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
12/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Gloria Zamayoa HernandezTIME COMPLETED:
12:35 PM
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On 12/12/2023 at 10:00 am, Licensing Program Analyst (LPA) Daniela Huerta, made an unannounced inspection to follow up on an incident that occurred at the facility on 04/01/2023. There were six (6) children and two assistants present during the inspection.

The LPA interviewed the staff present and attempted to interview all six (6) children. No deficiencies were cited during today's inspection.

An exit interview was conducted, and the report was reviewed with the Licensee, Gloria Zamayoa Hernandez. The licensee was provided a copy of their appeal rights (LIC9058), Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00.

This is an amended version of the original report created on 12/12/2023.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Daniela Huerta
LICENSING EVALUATOR SIGNATURE: DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/29/2023
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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