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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629087
Report Date: 12/16/2022
Date Signed: 12/16/2022 09:12:44 AM

Document Has Been Signed on 12/16/2022 09:12 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: 1DATE:
12/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Michele Galvez TIME COMPLETED:
09:15 AM
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On 12/16/2022 at 8:30 a.m., Licensing Program Analyst (LPA), Rajani Goudreau, made a unannounced Case Management tele-visit in order to deliver amended reports originally created on 12/09/2022.  Upon inspection, LPA met with Licensee, Michele Galvez and proceeded to tour the home. During the inspection there was one child in care and licensees' two minor children present in the home. 

No deficiencies issued during today's inspection. An exit interview was conducted with Licensee, Michele Galvez. LIC9213 - Notice of Site Visit was provided to licensee. LPA informed licensee Notice of Site visit shall be posted for 30 days from today's date. LPA observed the Notice of Site Visit posted near the front entrance of the front door.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2022
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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