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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376620696
Report Date: 12/20/2023
Date Signed: 12/20/2023 04:46:59 PM

Document Has Been Signed on 12/20/2023 04:46 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:PEREZ, ELENA FAMILY CHILD CAREFACILITY NUMBER:
376620696
ADMINISTRATOR:ELENA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 248-0747
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Elena PerezTIME COMPLETED:
05:00 PM
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On December 20, 2023 at 4:00 PM Licensing Program Analyst (LPA) Gloria Gonzalez conducted an unannounced, Licensee initiated, case management inspection to add the other half of the backyard that was previously Licensed and met with Licensee, Elena Perez. LPA disclosed the purpose of the inspection and was granted entry by the Licensee. No children were present during todays inspection.
 
Licensee stated she had closed off half of her backyard during the pandemic for personal use, but has now accommodated the entire backyard to be used by daycare children and would like to add it back as daycare space. Licensee will now utilize the entire backyard except for the side of the house that is fenced off.

Licensee submitted an updated application LIC279, written statement of request, and facility sketch LIC999 on 11/13/23.
 
Licensee accompanied LPA on a tour of the home and the backyard, as shown on the updated facility sketch. LPA did not see any hazardous items and is safe for daycare children to use. The entire backyard may be used as of today, 12/20/23 for daycare use.
 
An exit interview was conducted with Licensee, Elena Perez. The licensee was provided a copy of their report and appeal rights (LIC 9058).
 
LPA provided notice of site visit, (LIC9213) and observed it being posted at the facility.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Gloria Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2023
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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