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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376613387
Report Date: 03/02/2022
Date Signed: 03/02/2022 12:27:28 PM

Document Has Been Signed on 03/02/2022 12:27 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:BAHENA, MARGARITA & ANDRES FAMILY CHILD CAREFACILITY NUMBER:
376613387
ADMINISTRATOR:MARGARITA BAHENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 231-1054
CITY:SAN DIEGOSTATE: CAZIP CODE:
92113
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
03/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Margarita BahenaTIME COMPLETED:
12:40 PM
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On 03/02/22 at 12:00PM, LPA Luigi Gargaro conducted an unannounced case management visit to the facility to deliver amended citations for ones that were originally issued to the day care on 02/22/22 and 08/18/21, respectively. Analyst reviewed the updated citations with Licensee Margarita Bahena, had her sign for them and printed and left a copy for her records.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2022
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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