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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376611214
Report Date: 06/23/2020
Date Signed: 06/23/2020 11:03:50 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:
06/23/2020
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Rebecca & Daniel Maxwell TIME COMPLETED:
11:06 AM
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Interim Regional Manager (RM), Carol Marcroft, Licensing Program Managers (LPMs) Jason Garay and Joe Carrasco, Licensing Program Analyst (LPA) Rajani Goudreau met with licensees, Rebecca & Daniel Maxwell for the purpose of delivering an order to Licensee/Facility of Immediate Exclusion from facility.

Licensees were provided the Immediate Exclusion Letter dated 06/22/20 indicating David Zamudio not have contact with clients in, any child care facilities or any other community care facility licensed by California Department of Social Service. LPA discussed the requirements regarding an exclusion of an individual from the Family Child Care Home. Licensee's acknowledge understanding of the requirements. Licensee were provide an copy of the Family child Care Home Addendum to Notification of Parent's Rights (LIC995B) and Licensees were advised of its requirements.

LPA conducted an exit interview with licensee's. LPA discussed and provided the following to licensees: order reflecting excluded individual, LIC809, LIC995B and appeal rights.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2020
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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