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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376630247
Report Date: 02/06/2025
Date Signed: 02/06/2025 09:11:30 AM

Document Has Been Signed on 02/06/2025 09:11 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:DOMINIQUE ALEXIS, MARIE FANETTE FCCFACILITY NUMBER:
376630247
ADMINISTRATOR/
DIRECTOR:		MARIE F. DOMINIQUE A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 373-3906
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/06/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Marie Dominique Alexis, ProviderTIME VISIT/
INSPECTION COMPLETED:
09:15 AM
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On 02/06/2025 at 8:30 am, Licensing Program Analyst (LPA) Diana Sanchez conducted an announced Pre-licensing inspection with provider Marie Dominique Alexis in response to the change of location application request. The purpose of the inspection is to ensure the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes.

LPA was able to toured and inspect the first floor, but was unable to inspect the second floor since provider forgot the upstairs bedrooms keys. LPA was unable to proceed with the inspection of the second floor therefore this inspection will be rescheduled for another date and application will remain pending until provider is able to open the bedrooms located in the second floor for inspection.

LPA Sanchez explained inspection report to provider, provider stated she understood. Exit interview conducted and report was reviewed with the provider, Marie Dominique Alexis.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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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