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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376621095
Report Date: 10/04/2024
Date Signed: 10/11/2024 06:19:46 AM

Document Has Been Signed on 10/11/2024 06:19 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, CHRISTINE & CANTUBA, CORAZON FCCFACILITY NUMBER:
376621095
ADMINISTRATOR/
DIRECTOR:		CHRISTINE PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 494-1116
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
10/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Christine PerezTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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On 10/04/24 at 12:30PM, Licensing Program Analyst (LPA) Adrian Castellon conducted an unannounced complaint inspection to the facility. During the complaint investigation, LPA became aware that a child in care's paperwork was not completed and maintained as required per Title 22 regulations

Licensee attempted to have parent sign forms. Licensee sent forms to parent electronically. Licensee contacted CDA to assist in having parent sign forms, but CDA was unable to help. A technical violation is issued on this date. LPA Castellon discussed regulation 102417(g)(7) with licensee on this date.

No citations issued.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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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