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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100864
Report Date: 09/01/2022
Date Signed: 09/01/2022 02:47:52 PM

Document Has Been Signed on 09/01/2022 02:47 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:BUENROSTRO, JANET FAMILY CHILD CAREFACILITY NUMBER:
376100864
ADMINISTRATOR:JANET BUENROSTROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 872-8737
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
09/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Janet BuenrostroTIME COMPLETED:
03:15 PM
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On 9/1/22 at 1:30pm LPA Patrick Ma made an unannounced CASE MANAGEMENT visit to investigate child injury incident reported on 8/15/22. LPA met with Licensee, Janet Buenrostro. Also present in the home were 6 daycare children (1 infant child) and Helper, Angelica Padilla-Velazqu. LPA Conducted interview with Licensee and staff, reviewed children's files, and received a copy of the children’s roster.

Licensee reported child 1 was injured at a local park. First Aid was applied and parents were contacted. Licensee reported there were 6 total children (1 infant) and 2 staff (including Licensee) at the park at time of incident. Pictures of the structure, park, and injury was provide to LPA.

The incident is considered an accident.

No deficiencies were cited.

Exit interview conducted and report was reviewed with the licensee Janet Buenrostro.



A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2022
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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