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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628476
Report Date: 05/04/2023
Date Signed: 05/04/2023 10:37:13 AM

Document Has Been Signed on 05/04/2023 10:37 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:LUCERO, KARLA FAMILY CHILD CAREFACILITY NUMBER:
376628476
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
05/04/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Karla Lucero, ProviderTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Diana Sanchez, made an unannounced Case Management inspection to the facility today and met with provider Karla Lucero. LPA advised provider the purpose of today’s visit is to verify that excluded person is no longer residing at the facility. Provider and LPA tour the facility inside out.
During today's inspection, there were 2 children and provider's husband present. Appropriate ratios and capacity were observed. Appropriate care & visual supervision was also observed during the inspection.
LPA verified that excluded person's belongings are no longer at the facility and is not longer residing in the facility.

An exit interview was conducted with Karla Lucero and a copy of this report left at the facility. Copy of this report shall be maintained in the facility for public review.

LPA observed provider placing the Notice to Cite Visit on the wall visible to parents during today’s inspection.

NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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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