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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376630119
Report Date: 10/18/2024
Date Signed: 10/18/2024 01:40:16 PM

Document Has Been Signed on 10/18/2024 01:40 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GAETAN, WISTER FAMILY CHILD CAREFACILITY NUMBER:
376630119
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 21CENSUS: DATE:
10/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Wister GaetanTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On October 18, 2024 @ 1:25 p.m. Licensing Program Analyst (LPAs) Angela Nguyen and conducted a case management inspection to deliver an amended report created 10/02/2024. LPA met with Licensee, Wister Gaetan to deliver the amended report. Licensee's mother, 4 day care children, one (1) child is under the age of 2, helper, Stephanie Lamontagne were present during this inspection.

No Deficiencies cited during the inspection. An exit interview was conducted with the licensee, Wister Gaetan. The licensee was provided a copy of their appeal rights (LIC 9058) and notice of site visit (LIC 9213). Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


LPA provided notice of site visit and observed it being posted at the facility.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Angela Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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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