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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376608782
Report Date: 02/27/2024
Date Signed: 02/27/2024 09:57:52 AM

Document Has Been Signed on 02/27/2024 09:57 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:RIVAS, ROSA & FAUSTO FAMILY CHILD CAREFACILITY NUMBER:
376608782
ADMINISTRATOR:ROSA RIVASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 475-4686
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
02/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Rosa RivasTIME COMPLETED:
10:00 AM
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On 2/27/24 at 8:45am, Licensing Program Analyst (LPA) Adrian Castellon conducted an unannounced case management inspection. The purpose of the inspection is to deliver amended complaint reports regarding an inspection conducted on 2/16/24.

This report will be used to memorialize the inspection. Amended LIC9099 and LIC9099d delivered on this date.

No citations issued on this date. Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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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