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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629184
Report Date: 09/25/2024
Date Signed: 09/27/2024 07:01:46 AM

Document Has Been Signed on 09/27/2024 07:01 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:BORDWELL, SHADY FAMILY CHILD CAREFACILITY NUMBER:
376629184
ADMINISTRATOR/
DIRECTOR:		SHADY BORDWELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 519-2549
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
09/25/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Shady BordwellTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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On 9/25/2024 at 2:15 p.m., Licensing Program Analysts (LPAs), Adrian Castellon and Danielle Anderson arrived to conduct an unannounced Plan of Correction (POC) inspection for deficiency cited on 9/13/2024.

Upon arrival, LPAs met with licensee Shady Bordwell, discussed the purpose of the inspection and toured the facility. There were five children present at the time of inspection.

On this date, LPA Anderson inspected licensee's bedroom and the facility bathroom. There is a day bed and night stand located in the bedroom. LPA Anderson checked bathroom and observed personal hygiene items, hair care products, and other personal items. LPA Anderson also inspected bedroom closet and observed adult clothing and shoes.

LPA Castellon obtained a facility roster.

The licensee was provided appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt these rights. LPA provided the Notice of Site Visit - LIC 9213. No deficiencies cited. An exit interview was conducted with licensee Shady Bordwell.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
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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