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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136609875
Report Date: 02/03/2022
Date Signed: 02/03/2022 02:58:03 PM

Document Has Been Signed on 02/03/2022 02:58 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:CHAVEZ, GRACIELA FAMILY CHILD CAREFACILITY NUMBER:
136609875
ADMINISTRATOR:GRACIELA CHAVEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 344-5048
CITY:BRAWLEYSTATE: CAZIP CODE:
92227
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
02/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:44 PM
MET WITH:Graciela ChavezTIME COMPLETED:
03:00 PM
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On 02/03/2022 at 2:45 PM, Licensing Program Analyst (LPA) Dana Stevens conducted and unannounced case management inspection to deliver amended complaint report (LIC9099) dated 01/21/2022. Two staff were present with 8 children at the time of this inspection.

No deficiencies cited.

Exit interview was conducted and Licensee was provided copy of this report and Appeal Rights (LIC9058). Notice of Site visit must be posted for 30 days.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2022
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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