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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101092
Report Date: 01/22/2024
Date Signed: 01/22/2024 12:29:22 PM

Document Has Been Signed on 01/22/2024 12:29 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:GONZALEZ, NICOLETTE FAMILY CHILD CAREFACILITY NUMBER:
376101092
ADMINISTRATOR:GONZALEZ, NICOLETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 642-7446
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
01/22/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Nicole GonzalezTIME COMPLETED:
12:45 PM
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On 1/22/24 at 12:00 PM, Licensing Program Analyst (LPA) Adrian Mangina conducted an announced case management inspection for the purpose of adding back yard space to the license. LPA met with the licensee Nicolette Gonzalez. Also in the home was Licensee’s assistants Anita Gonzelez and Sarah Weil, husband Juan Gonzalez and three children in care. The 2-bedroom, 1-bathroom single story home and back yard was toured and inspected to ensure an environment safe for the care and supervision of children. Per applicant operating hours are from 6;00 AM to 6:00 PM Monday through Friday.

The following areas will be used for the daycare: living room, nap room, bathroom, fenced back yard. The following areas will be off limits: bedroom , kitchen, attached garage, side and front yards, which are inaccessible using safety gates, latches, locks, and doorknob covers. Additional space was found to be safe for the care and supervision of children. Licensee provided an updated LIC999A to reflect added outdoor space in back yard.

Exit interview conducted with Licensee Nicolette Gonzalez and Notice of Site visit provided.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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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