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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376617458
Report Date: 09/01/2022
Date Signed: 09/01/2022 05:53:25 PM

Document Has Been Signed on 09/01/2022 05:53 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:TORRES-HERNANDEZ, IRMA FAMILY CHILD CAREFACILITY NUMBER:
376617458
ADMINISTRATOR:IRMA TORRES-HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 583-2024
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
09/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:36 PM
MET WITH:Irma TorresTIME COMPLETED:
05:55 PM
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LPA Block conducted an unannounced Case Management visit for the purpose of having the amended report dated 8/23/22 signed by licensee. The report was signed and licensee was given an updated copy to post along with the Notice of Site Visit.

An exit interview was conducted with Irma Torres-Hernandez and the Notice of Site Visit must be posted for 30 days.

Translation was provided by her daughter, Carolina.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2022
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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