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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626552
Report Date: 08/05/2024
Date Signed: 08/05/2024 04:41:09 PM

Document Has Been Signed on 08/05/2024 04:41 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MIRANDA, MARIA FAMILY CHILD CAREFACILITY NUMBER:
376626552
ADMINISTRATOR/
DIRECTOR:		MARIA MIRANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 274-3322
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
08/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:10 PM
MET WITH:Maria MirandaTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
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On 08/05/2024 at 3:15 pm, Licensing Program Analysts (LPAs) Michelle Hood and Shannan Williams conducted an unannounced Case Management inspection. The LPAs met with Licensee Maria Miranda. The purpose of the inspection is to follow-up on a Criminal Record Exemption for an Individual. There were two school-age children present at the time of the inspection.

LPA Hood and Licensee discussed the Additional Information Needed for a Criminal Record Exemption, and LPA Hood provided the licensee with a copy of the letter dated 06/26/2024. The licensee stated the additional documents was emailed to the Care Provider Management Branch (CPMB) and the licensee stated she informed her assigned LPA Dana Stevens on 07/10/2024 via text message. The licensee was reminded the individual cannot reside in the home or supervise children until an exemption has been granted.

An exit interview was conducted and the report was reviewed with the licensee Maria Miranda. The licensee was provided a copy of their appeal rights (LIC 9058 03/2022) and their signature on this form acknowledges receipt of these rights. Notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. No deficiencies were cited
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2024
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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