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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376620696
Report Date: 09/27/2022
Date Signed: 09/27/2022 09:58:47 AM

Document Has Been Signed on 09/27/2022 09:58 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:PEREZ, ELENA FAMILY CHILD CAREFACILITY NUMBER:
376620696
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 2CENSUS: 0DATE:
09/27/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:59 AM
MET WITH:Elena Perez TIME COMPLETED:
10:00 AM
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On 09/27/22 at 8:59 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an unannounced licensee-initiated inspection for the purpose of a capacity increase. Upon arrival LPA met with the Licensee, Elena Perez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. There were no children in care at time of inspection. This facility is a one story, three-bedroom and 2 ½ bathroom home. The following areas are used for childcare: living room, kitchen, daycare room (located near kitchen), restroom located in daycare room, covered patio, and partial of backyard. The following off-limit areas are made securely inaccessible: front yard, left side of backyard, master bedroom, master bathroom, two bedrooms, restroom located in hallway of home and garage. Operation hours are Monday through Friday from 6:00 a.m. to 6:00 p.m.

All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children and poisons shall be locked away. LPA observed the fire extinguisher, smoke and carbon monoxide detectors meet requirements and are operational. LPA observed required postings posted. Children’s toys and play equipment are safe and age appropriate. Annual inspection was conducted on August 03, 2022. Fire clearance on file and approved on September 08, 2022 with the condition the garage shall not be used for childcare. Licensee acknowledges understanding the garage shall not be used for childcare. Large visual ratio handout discussed and provided to licensee during the inspection.

No deficiencies issued during today’s inspection. After final file review a large family childcare license shall be issued and mailed to licensee. LPA informed license once the license is received to ensure the license is posted in a prominent location in the home. LIC9213 – Notice of Site Visit shall be posted for 30 days from today’s date. Exit interview conducted with Licensee, Elena Perez.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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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