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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376616187
Report Date: 05/21/2021
Date Signed: 05/25/2021 07:40:28 AM

Document Has Been Signed on 05/25/2021 07:40 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:ALEXANDER, MICHELLE A. FAMILY CHILD CAREFACILITY NUMBER:
376616187
ADMINISTRATOR:MICHELLE A. ALEXANDERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 263-6562
CITY:SAN DIEGOSTATE: CAZIP CODE:
92113
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/21/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Michelle AlexanderTIME COMPLETED:
03:30 PM
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On 05/21/2021 at 3:00pm, Licensing Program Analyst (LPA), Adrian Castellon conducted an unannounced virtual case management inspection via FaceTime due to COVID-19 and met with licensee Michelle Aklexander. There were no children in care on today's date..

The purpose of the inspection is to follow up on an unusual incident/injury report (LIC624B) submitted to the licensing office by licensee Alexander. The report was received on 05/19/21. LPA Castellon offered support and resources to licensee Alexander on this date. PIN 19-14-CCP, SIDS Peer Grief Support, Recognizing and Reducing Anxiety, Counseling Options, Impacts of a Traumatic Event, Coping with Grief, and other materials were emailed to licensee Alexander.

Licensee reports no issues or concerns. No citations issued on this date.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2021
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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