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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628673
Report Date: 08/17/2022
Date Signed: 08/17/2022 01:03:23 PM

Document Has Been Signed on 08/17/2022 01:03 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:MAGANA, MIRIAM FAMILY CHILD CAREFACILITY NUMBER:
376628673
ADMINISTRATOR:MIRIAM MAGANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 273-7012
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
08/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Jose Luis MaganaTIME COMPLETED:
01:15 PM
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On 08/17/2022 at 12:30 PM, Licensing Program Analyst (LPA) Dana Stevens, conducted an unannounced Case Management visit for the purpose of amending Annual Required Inspection report dated 08/12/2022. LPA met with Licensee's spouse/assistant and was granted entry into the facility. There were 12 children present with one additional assistant at the time of this visit.

Community Care Licensing WEB SITE: http://www.ccld.ca.gov

Exit interview was conducted with Miriam Magana and a copy of this report and appeal rights were provided to Licensee.
NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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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