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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417009
Report Date: 03/26/2025
Date Signed: 03/26/2025 03:51:18 PM

Document Has Been Signed on 03/26/2025 03:51 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MILLS FAMILY CHILD CAREFACILITY NUMBER:
197417009
ADMINISTRATOR/
DIRECTOR:		MILLS, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 202-2532
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
03/26/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Maria MillsTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On 3/26/2025, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Required 3-Year inspection at the Mills Family Child Care. Upon arrival, the LPA met with the licensee, Maria Mills, who guided the LPA on a facility tour. Individuals that reside in the home include 2 adults (the licensee and the licensee’s husband) and no children. During this inspection, 7 childcare children and 2 assistant were present. Per the licensee, the hours of operation are Monday through Friday, 7:00 a.m. to 5:30 p.m. Incidental Medical Services (IMS) were discussed. Per the licensee, she does not have children who need IMS.
The home is set up as follows:
This is a single story 3 bedroom, 2.5-bathroom (main house) home with kitchen and dining, living room, formal dining room, laundry room, bonus room, family room, detached garage/workshop (Child Care) with partitions, and garage (two attached to the home). The garages are used for storage only, and no childcare activities are conducted there. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The house has central heating and air conditioning. All windows have screens free of cracks, bugs, and debris. There is an in-ground pool and spa on the premises.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2025
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 03/26/2025 03:51 PM - It Cannot Be Edited


Created By: Carol Heath On 03/26/2025 at 03:05 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MILLS FAMILY CHILD CARE
FACILITY NUMBER: 197417009

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(1)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (1) The swimming pool shall be equipped with, at minimum, the following drowning prevention safety features:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. During today's visit, LPAs did not observed the new pool equipment and the daily log. According to the licensee, she did received the PIN however,the licensee though she had a lock on the pool gate and she would not need the pool alarm/ cover and other equipment, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/11/2025
Plan of Correction
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The licensee will email the pictures and video for all the equipment and email the daily check log for LPA by 4/11/2025
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:
Carol Heath
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2025


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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MILLS FAMILY CHILD CARE
FACILITY NUMBER: 197417009
VISIT DATE: 03/26/2025
NARRATIVE
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Main Area: Main care is provided in the side yard structure (garage/workshop with partitioner), which has a bathroom and kitchen, and the children use the rear yard of the home for outdoor activities.
Playroom Room/Formal Dining Room/ Family Room: In the designated childcare areas, LPA observed age-appropriate toys and furniture for the children. Two tables with a total of 6 chairs were observed. Several plastic storage bins were observed in which games and toys are stored for the children. There are games and books on the premises of this facility. There are mats on the floor with educational/learning activities. The mats were observed to be in good condition. A TV plays educational videos for children and an adult-size couch. In the family room, additional toys were observed to be stored in cubbies.
Children's bathroom (#1): Bathroom: Children will use the bathroom down the hall to the left. The bathroom was toured and inspected, and the sink/toilet is in operable condition. Toilet and faucets are clean, safe, and operable. All poison and medications are inaccessible to children with child safety latches on the sink cabinet. The bathroom was observed to be free and clear of hazardous items. The bathroom was clean, sanitized, and in good repair.
Kitchen/Dining Room: The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children (Safety latches). Sharp utensils, poisons, and medications are unavailable to children in the kitchen, and child safety latches are on cabinet doors and drawers. Sharp knives are kept in a butcher block in the gated kitchen.
Backyard (main house): The backyard was inspected; The children use the outside backyard for outside play. The backyard is gated all around. The outdoor play area was observed to be free of hazards and loose and sharp parts. LPA observed a grass and concrete area for active play.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MILLS FAMILY CHILD CARE
FACILITY NUMBER: 197417009
VISIT DATE: 03/26/2025
NARRATIVE
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There are tiny tots, swings and slides, a house (with padding), a sandbox, and a water table. There are two sheds with key locks, roses are screened, the barbecue grill has a cover, and the area on the left rear is gated (storing toys).
Off-limit: Off-limit areas include the main home's entire upstairs (4 bedrooms, two bathrooms) with safety gate, downstairs bedroom (key lock), hallway closet (key lock), and the garage.
Others:
The AC/Heating Unit was observed. It is located on the right side of the home and is inaccessible to children due to barrels blocking access to it.
Bodies of water: LPA observed a swimming pool fully barricaded with a self-closing and self-latching mesh fence that meets Title 22 regulations. LPA observed the fences and gates swinging away from the pool. LPA observed age-appropriate toys. In addition, the following safety equipment were not observed and visible from the swimming pool and readily accessible for immediate use: A life ring with a minimum exterior diameter of 17 inches, approved by the United States Coast Guard—a rescue pole equipped with a body hook, with a minimum fixed length of 12 feet. LPA also observed the pool safety log. The licensee will need to inspects drowning prevention safety features and equipment daily before opening. In addition, the pool alarm or pool cover was not present. According to the licensee, she did received the PIN however, the licensee though she had a lock on the pool gate and she would not need the pool alarm/ cover.
The licensee understands and agrees that the swimming pool fencing will remain in place whenever licensed care is provided, so long as the mesh fence makes the swimming pool inaccessible to children, as determined by licensing staff. No items around the perimeter of the fence would allow the fence to be climbable. The licensee purchased all the equipment during the inspection.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC809 (FAS) - (06/04)
Page: 5 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MILLS FAMILY CHILD CARE
FACILITY NUMBER: 197417009
VISIT DATE: 03/26/2025
NARRATIVE
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Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
Fire extinguisher (2A10BC): LPA observed a required fire extinguisher (2A10BC) reading in Green, located in the kitchen, and inaccessible to children. It meets standards established by the State Fire Marshall.
Fireplace: In the family room, a fireplace was observed that was properly screened via mirror glass doors. The fireplace is inaccessible to children.
Hanging window blind cords: The cords are inaccessible to children.
Isolation area (Illness): Per the licensee, if the child shows signs of illness, they will be separated from other children and stay in Hallway next to the classroom
Medications and cleaning solutions: Detergents and cleaning compounds are in the upper kitchen cabinet, and medications are in the off-limits bedroom.
Napping: Children will nap in the designated nap areas with adult supervision. LPA observed 14 mats in the closet.
Overnight Care: According to the licensee, it does not provide overnight care.
Pets: No pet
Phone service: There is a working landline or cell phone
Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested operable.
The first aid kit is in the bathroom closet and is inaccessible to children. The First Aid Kit was observed to be complete with supplies and a first aid manual.
Transportation: The licensee does not provide transportation for children.
Weapons or Firearms: Per the licensee, there are No Firearms at the facility at this time. LPA does not observe any firearms.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC809 (FAS) - (06/04)
Page: 6 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MILLS FAMILY CHILD CARE
FACILITY NUMBER: 197417009
VISIT DATE: 03/26/2025
NARRATIVE
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Documentation:
Child files: LPA observed that 5 children's files contained all required licensing documents.
Infant Sleeping Plan (LIC 9227) and Sleeping Log: LPA observed that 2 infants have LIC 9227, and the sleeping log is also in each infant's file; the license follows the Safe Sleep Regulation.
Staff Personnel File: During an annual inspection., LPA observed 2 staff information. LPA observed LIC 508, 9052, IZ, TB test, LIC 9108, Mandated Reporter Training, and CPR/First Aid certificates. The file contained all required licensing documents.
Immunization: The licensee and her assistants have the required immunizations (MMR and DTaP). The licensee and her assistants provided a written statement declining the influenza vaccination.
Criminal Record: Per Guardian, all adults who live in this facility obtain a criminal record clearance.
CPR/First Aid: LPA observed that the licensee has current Pediatric CPR and First Aid Training with an expiration date (of 09/2026) 1 hour of nutrition training and (8) hours of Preventive Health and Safety Training.
Mandated Reporter Training: The licensee has completed and renewed the online mandated reporter training at www.mandatedreporterca.com on 7/2025
Facility fees: Per the Licensing Information System, annual facility fees were current.
Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on every month.
LPA observed the licensee has posted as required the Facility License, Emergency Disaster plan, Earthquake Preparedness, and Parents' Rights Poster.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MILLS FAMILY CHILD CARE
FACILITY NUMBER: 197417009
VISIT DATE: 03/26/2025
NARRATIVE
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The following information was discussed with the licensee:
o A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code sections 1596.848(b) and (c). State law prohibits baby walkers, bouncy seats, exersaucer, and other items that fall into that category.
o Capacity requirements, Roster requirements, Posting requirements, and Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children's and provider's files and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
o The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
o Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility's phone number; if the phone number is changed, licensing must be notified.
o Mandatory Forms for the children's files and provider's files.
o Our Quarterly updates come out every 3 months. They are also now in Spanish. Please log in to the CCLD website, or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
o Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC809 (FAS) - (06/04)
Page: 8 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MILLS FAMILY CHILD CARE
FACILITY NUMBER: 197417009
VISIT DATE: 03/26/2025
NARRATIVE
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o Requirements for fire drills, earthquake drills, and documentation for both.
o The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.
o The licensee is reminded that 100% supervision is required for children at all times.
o The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
o The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family childcare home where children are present (24/7 ban).
· Family Child Care Homes Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
· IF THERE IS NO CHILD AT THE FACILITY THAT CURRENTLY NEEDS IMS, USE AS FOLLOWS: Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC809 (FAS) - (06/04)
Page: 9 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MILLS FAMILY CHILD CARE
FACILITY NUMBER: 197417009
VISIT DATE: 03/26/2025
NARRATIVE
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· Centers and Family Child Care Homes Licensee [or facility representative] was informed of the MyChildCarePlan.org website, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
· Family Child Care Homes During the exit interview, the LICENSEE **** confirmed that no Registered Sex Offenders live in the facility, and LPA completed the RSO profile in FAS.
· Family Child Care Homes: A notice of site visit was given and must remain posted for 30 days.
· To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-carelicensing/ inspection-process.

Deficiencies cited: (See LIC 809D). The following Type B deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes

An exit interview was conducted, and the report was reviewed with the licensee, Maria Mills.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC809 (FAS) - (06/04)
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