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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376611214
Report Date: 11/29/2021
Date Signed: 11/29/2021 01:35:21 PM

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: 2DATE:
11/29/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Rebecca Maxwell TIME COMPLETED:
01:50 PM
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On 11/29/21 at 1:14 p.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted a case management inspection regarding a Non-Compliance Plan dated June 23rd,2020 . Upon visit, LPA met with Licensee, Rebecca Maxwell and discussed the reason for the visit and proceeded to tour the facility. During the visit there were two children in care. Facility operates Monday through Friday, 24 hours a day.

LPA reviewed the Self-Assessment Guide. LPA confirmed the LIC9224 - Acknowledgement of Receipt of Licensing Reports and LIC995B – Family child Care Home Addendum to Notification of Parent's Rights were signed and placed in each child’s file.

No deficiencies issued during today's visit. An exit interview was conducted with licensee. LPA discussed and provided the following to licensee: LIC809 and LIC9213-Notice of Site Visit. Notice of Site Visit (LIC9213) shall be posted for 30 days from today's date.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
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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