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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376629087
Report Date: 10/17/2022
Date Signed: 10/17/2022 02:16:44 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/06/2022 and conducted by Evaluator Rajani Goudreau
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20221006163017
FACILITY NAME:GALVEZ, MICHELE FAMILY CHILDCAREFACILITY NUMBER:
376629087
ADMINISTRATOR:MICHELE GALVEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 703-5839
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:14CENSUS: 7DATE:
10/17/2022
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Michele Galvez TIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Licensee allows an uncleared adult to supervise and care for children
INVESTIGATION FINDINGS:
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On 10/17/22 at 12:45 p.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an unannounced complaint inspection in order to deliver the finding to the above listed allegation. Upon arrival, LPA met with Licensee, Michele Galvez and discussed reason for inspection. During the inspection there were seven children in care; including two infants, four preschool age and one school age.

On October 06, 2022, Community Care Licensing (CCL) received a complaint alleging licensee allows uncleared adult to supervise and care for children. On October 12, 2022, during an interview with licensee, licensee admitted to resident #1 (R1; see LIC811 confidential names) residing in the home since the beginning of September 2022. Licensee stated, R1 does not supervise or care for the children. Based on R1’s statement, R1 admitted to residing in the home. During an inspection on October 12, 2022, LPA observed R1 in the home during the inspection.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 20-CC-20221006163017
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GALVEZ, MICHELE FAMILY CHILDCARE
FACILITY NUMBER: 376629087
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/18/2022
Section Cited
CCR
102370(d)(1)
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Criminal Record Clearance: CCR 102370(d)(1). (d) All individuals subject to a criminal record review...shall prior…residing…in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department…This requirement was not met as evidenced by:
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Licensee stated, R1 obtained a criminal record clearance on October 12, 2022. Licensee provided the LIC9163-Request for Live Scan reflecting completion of the live scan for R1.
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Based on observation and interviews conducted, the Licensee did not comply with the section cited above as R1 did not obtain a criminal record clearance prior to residing in the home, which, poses an immediate health, safety or personal rights risk to the children in care.
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Licensee stated she will review CCR 102370 - Criminal Record Clearance and provide an outline of the regulations to the department. Plan of correction shall be submitted to the department on 10/18/22.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 20-CC-20221006163017
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GALVEZ, MICHELE FAMILY CHILDCARE
FACILITY NUMBER: 376629087
VISIT DATE: 10/17/2022
NARRATIVE
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 This is an amended version of the original report created on October 17, 2022.
Based on licensees, R1’s admission's, observation made, and criminal record clearance association review, the preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated. California Code of Regulations, (Title 22, Division 12 & Chapter 3), is being cited on the attached LIC 9099D and an immediate civil penalty of five hundred dollars ($500), is being assessed on the attached LIC 421BG.

LPA, Rajani Goudreau informed Licensee, Michele Galvez that this report dated 10/17/2022 documents one Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care. Also, LPA, Rajani Goudreau informed the Licensee, Michele Galvez to provide a copy of this licensing report dated 10/17/2022 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. LIC9213 - Notice of Site Visit was discussed and provided to licensee. LPA observed licensee post the LIC9213 near the front door, prior to exiting the facility. Exit interview conducted and report was reviewed with the Licensee, Michele Galvez.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4