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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376611214
Report Date: 05/21/2020
Date Signed: 05/21/2020 08:25:56 AM

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:MAXWELL, REBECCA & DANIEL FAMILY CHILD CAREFACILITY NUMBER:
376611214
ADMINISTRATOR:MAXWELL, REBECCAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 419-9219
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:14CENSUS: 0DATE:
05/21/2020
TYPE OF VISIT:Case Management - DeficienciesANNOUNCEDTIME BEGAN:
08:11 AM
MET WITH:Rebecca Maxwell TIME COMPLETED:
08:40 AM
NARRATIVE
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On 05/21/20 at 8:11 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted a case management deficiency tele-inspection. During visit LPA met with licensee, Rebecca Maxwell and proceeded to virtually tour the
facility. There were no children in care at time of visit. Facility operates Monday through Friday from 6:00 a.m. to 6:00 p.m.

Based on licensees’ admission, on 2/12/2020, licensee placed a 6-month old infant, child #1 on an adult bed to nap and left the child unsupervised for an undermined amount of time. LPA discussed with licensee safe sleep practices for infants in care. Licensee acknowledges understanding of requirements.

Facility was cited one type B deficiency during today’s visit (see same day 809-D citation page). An exit interview was conducted with licensee. LPA discussed and will provide the following to licensee via email: LIC809, LIC809-D, appeal rights (LIC 9058) and Notice of Site Visit (LIC9213). LPA informed licensee LIC9213 shall be posted for 30 days from today’s date. COVID-19 State of emergency read receipt notification will be used in place of licensees’ signature.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: MAXWELL, REBECCA & DANIEL FAMILY CHILD CARE
FACILITY NUMBER: 376611214
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/29/2020
Section Cited

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102423 Personal Rights (a) Each child receiving services from a family childcare home shall have certain rights that shall not be waived or abridged by the licensee…These rights include…(2)-To receive safe,healthful... accommodations.This requirement was not met as evidenced by:
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Based on licensee’s admission, licensee did not ensure C1 received safe, healthful accommodations, which poses a potential health and safety risk to children in care.
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sleep practices are followed during day care operation.Plan of correction is to be submitted by:05/29/20 via email to LPA, Rajani Goudreau at Rajani.Goudreau@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.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:
DATE: 05/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2020
LIC809 (FAS) - (06/04)
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