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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629087
Report Date: 06/11/2025
Date Signed: 06/11/2025 03:59:42 PM

Document Has Been Signed on 06/11/2025 03:59 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GALVEZ, MICHELE FAMILY CHILDCAREFACILITY NUMBER:
376629087
ADMINISTRATOR/
DIRECTOR:		MICHELE GALVEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 703-5839
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/11/2025
TYPE OF VISIT:Case Management - DeficienciesANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:41 PM
MET WITH:Michele GalvezTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On June 11, 2025, at 12:41 p.m., Licensing Program Analyst (LPA) Angela Nguyen conducted an office meeting for the purpose of issuing citations in conjunction with complaint investigations received on 3/20/2025 and 04/17/2025. LPA met with Licensee, Michele Galvez who stated she is currently not providing child care and the facility is on inactive status as of May 1, 2025.

A review of the facility association indicates the adult that retrieved and made contact with the child that wandered away from the facility on or about 04/16/2025 does not have a criminal record clearance. An immediate $100 civil penalty was assessed. (See LIC 421BG)

The licensee did not report the incident of the child wandering away from the facility to the child's authorized representative on the day of the incident or to the Department within 24 hours as required.

During the course of the complaint investigation, it was determined that the day care children have access to an off- limits area, Bedroom #2 on multiple occasions while the licensee was not present in the home.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, (1) Type A and (3) Type B deficiencies are being cited on the attached LIC 809D.

An exit interview was conducted and the report was reviewed with Licensee, Michele Galvez.
NAME OF LICENSING PROGRAM MANAGER: Tulam Vu
NAME OF LICENSING PROGRAM ANALYST: Angela Nguyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/11/2025 03:59 PM - It Cannot Be Edited


Created By: Angela Nguyen On 06/09/2025 at 11:35 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 06/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/12/2025
Section Cited
CCR
102370(d)(1)

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102370 Criminal Record Clearance (d)All individuals subject to a criminal record review.... shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption...
This requirement was not met as evidence by:
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Licensee stated she will ensure that all adults residing at the facility will obtain a criminal record clearance or exemption. Licensee stated she will watch Child care Licensing- Background check requirement for Caregivers and submit a written summary to the Department no later than 06/12/2025
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Based on Licensee's admission and photos evidence, the licensee did not comply with the section cited above by not ensuring all adults residing in the home obtained criminal record clearance or exemptions prior to initial presence which posed an immediate health and safety risk to persons in care.
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acknowledging her understanding and compliance with the regulation.

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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.
Tulam Vu
NAME OF LICENSING PROGRAM MANAGER:
Angela Nguyen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/11/2025 03:59 PM - It Cannot Be Edited


Created By: Angela Nguyen On 06/09/2025 at 03:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 06/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2025
Section Cited
CCR
102416.2(a)(6)

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(a) Prior to making alterations or additions to ... grounds, the licensee shall notify the Department ...: (6) Any change ... previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
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Licensee stated she will ensure the day care children remain in the day care areas by making Bedroom #2 door inaccessible by installing child proof locks on the exterior of the bedroom door and inspecting the door is secured prior to day care children arrival.
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Based on interviews the licensee did not comply with the section cited above in not notifying the Department and allowing day care children to access an off limits area (Bedroom #2) which posed a potential health, safety or personal rights risk to persons in care.
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 Licensee stated she will advise her daughter to keep her bedroom door closed and conduct daily checks to ensure the door remains closed.
Type B
06/20/2025
Section Cited
CCR102416.2(g)

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102416.2 Reporting Requirements(g) ... no later than the same business day, the licensee shall notify a child's parent or authorized representative of the events to be reported to the Department... affect that child.

This requirement was not met by evidenced by:
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Licensee stated she will report all incidents to the child's authorized representative the day an incident occurs. Licensee stated she will create an ouchie report to document injuries stating the date, decription of the incident and when it was reported to parents on the day of the incident.
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Based on interviews, the licensee did not comply with the section cited above by not reporting to the child's authorized representative that the child wandered away from the facility on 04/16/2025 which posed a potential health, safely risk to persons in care.
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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.
Tulam Vu
NAME OF LICENSING PROGRAM MANAGER:
Angela Nguyen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/11/2025 03:59 PM - It Cannot Be Edited


Created By: Angela Nguyen On 06/10/2025 at 12:57 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 06/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2025
Section Cited
CCR
102416.2(b)(2)

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(b) The licensee shall report to the Department any of the events... that occur during the operation of the family child care home. (2) Any child absence means any instance where a child in care is missing... shall be reported...
This requirement is not met by evidenced by:
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Licensee stated she will ensure that all unusual incidents that require medical attention are reported to the Department within 24 hours and a written LIC624B within 7 days of the incident. Licensee stated she will review the reporting requirements regulation and submit a written statement
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Based on interview and record review, the licensee did not comply with the section cited above by not reporting to the Department of the absence of supervision that occured on 04/16/2025 within 24hrs of the incident which posed a potential health and safety risk to persons in care.
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acknowledging her understanding and compliance to the Department no later than 06/20/2025. LPA provided 102416.2 Reporting Requirements regulation and LIC 624 forher records and review. Duty Line #: (619)767-2248 Email: SDincidentReports@dss.ca.gov

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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.
Tulam Vu
NAME OF LICENSING PROGRAM MANAGER:
Angela Nguyen
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2025


LIC809 (FAS) - (06/04)
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