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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629087
Report Date: 12/09/2022
Date Signed: 12/15/2022 08:59:45 AM

Document Has Been Signed on 12/15/2022 08:59 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:GALVEZ, MICHELE FAMILY CHILDCAREFACILITY NUMBER:
376629087
ADMINISTRATOR:MICHELE GALVEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 703-5839
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
12/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Michele Galvez TIME COMPLETED:
04:35 PM
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On 12/09/2022 at 4:30 p.m., Licensing Program Analyst (LPA), Rajani Goudreau, made a unannounced Case Management inspection in order to deliver an amended report originally created on 10/17/2022.  Upon inspection, LPA met Licensee, Michele Galvez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. During this inspection there were six children in care; including two school age, one infant and three preschool age children.
 
No deficiencies issued during today's visit. LPA informed the director Notice of Site visit shall be posted for 30 days from today's date. Exit interview conducted with 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
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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