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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334819709
Report Date: 11/29/2022
Date Signed: 11/29/2022 08:40:04 AM


Document Has Been Signed on 11/29/2022 08:40 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:ANDERSON-CULTON FAMILY CHILD CAREFACILITY NUMBER:
334819709
ADMINISTRATOR:ANDERSON-CULTON, RHONDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 805-6542
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92532
CAPACITY:14CENSUS: 0DATE:
11/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Rhonda Anderson-CultonTIME COMPLETED:
08:45 AM
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Licensing Program Analyst (LPA) Alaina Wilburn arrived at the facility to conduct a case management visit. LPA met with Licensee Rhonda Anderson-Culton. Mrs. Anderson-Culton advised that she would like to be placed on inactive status. Licensee was provided with Request for Inactive Status Form, LIC9211. Licensee completed LIC9211 and requested inactive status from 11/29/2022 through 11/29/2023.

LPA reminded Licensee that annual license fees must be paid promptly and before reopening the day-care. Mrs. Anderson-Culton will contact the Department, if she wishes to end Inactive status early, or to extend Inactive Status once it expires. .

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.

Exit interview was conducted with Rhonda Anderson-Culton and a copy of this report was provided during visit. Copy of report must be maintained for 3 years and available to the public upon request.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022
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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