Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376618722
Report Date: 10/11/2016
Date Signed: 10/11/2016 04:40:13 PM

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:ARINDUQUE, KATHI FAMILY CHILD CAREFACILITY NUMBER:
376618722
ADMINISTRATOR:KATHI ARINDUQUEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 475-0262
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:14CENSUS: 12DATE:
10/11/2016
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:05 PM
MET WITH:Kathi ArinduqueTIME COMPLETED:
04:50 PM
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Licensing Program Analyst Selina Siao conducted a plan of correction visit today to ensure the citations issued on 09/21/2016 are now in compliance.

Upon arrival there were 13 school age children at the facility and 6 of the children are licensee's grand children and one resides at the facility and is older than 10 years old therefore does not count in the capacity. Adults at the home today includes licensee, Licensee's spouse Edwin Arinduque, licensee's adult sons Ricky Arinduque and Edwin Arinduque which all adults have the required background clearance and are associated to the facility.

The facility now has an operating carbon monoxide detector, no hazardous are accessible in the kitchen or bathroom, facility is within ratio and no personal rights violation is observed during today's visit.

Children's records are reviewed and all the children in care today has the Acknowledgement received of licensing report form (LIC9224) signed and the notice of site visit and the report are posted next to the entrance.

Facility is within substantial compliance during today's visit
SUPERVISOR'S NAME: Carol AugustTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2016
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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