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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628579
Report Date: 01/06/2022
Date Signed: 01/06/2022 11:48:06 AM

Document Has Been Signed on 01/06/2022 11:48 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:SARABIA, A. & GONZALEZ, G. FAMILY CHILD CAREFACILITY NUMBER:
376628579
ADMINISTRATOR:A. SARABIA & G. GONZALEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 245-8499
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
01/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Guillermina Gonzalez, LicenseeTIME COMPLETED:
12:15 PM
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On 01/06/2022 at 11:20 am., Licensing Program Analysts (LPAs), Michelle Hood and Marisol Lopez (Residential), made an unannounced inspection to follow up on an incident that occurred on 12/27/2021, between the licensees and a foster child from Orange County. The facility is listed as a dual license with foster. During this inspection, there were two children in care.

LPAs interviewed the licensees. On 12/27/2021, there were no children when the incident occurred. LPA reviewed the sign in log from 12/27/2021. LPA determined there were no daycare children in care when the incident occurred.

No deficiencies are cited. Provided Notice of Site Visit (LIC 9213). Exit interview conducted with Guillermina Gonzalez. LPA observed licensee post the LIC 9213.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2022
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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