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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628634
Report Date: 11/07/2023
Date Signed: 11/07/2023 03:20:57 PM

Document Has Been Signed on 11/07/2023 03:20 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:AJA MAZA, NATALIA FAMILY CHILD CAREFACILITY NUMBER:
376628634
ADMINISTRATOR:NATALIA AJA MAZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 890-5885
CITY:SAN DIEGOSTATE: CAZIP CODE:
92107
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
11/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Natalia Aja MazaTIME COMPLETED:
03:30 PM
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On 11/07/2023 at 3:15 PM, LPA Dana Stevens conducted an unannounced Case Management visit for the purpose of amending complaint report dated 09/14/2023.
LPA met with Licensee Natalia Aja Meza. There were 6 preschool children present at the time of this inspection.

An exit interview was conducted and a copy of this report was provided to Licensee.
The Notice of Site Visit (LIC 9213) is to be posted for thirty (30) days
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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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