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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312729
Report Date: 04/08/2025
Date Signed: 04/08/2025 11:35:21 AM

Document Has Been Signed on 04/08/2025 11:35 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GALVEZ, GLORIAFACILITY NUMBER:
304312729
ADMINISTRATOR/
DIRECTOR:		GLAVEZ, GLORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 566-4587
CITY:ALISO VIEJOSTATE: CAZIP CODE:
92656
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
04/08/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Gloria Galvez, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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On 4/08/2025 at 9:50am, Licensing Program Analyst (LPA) Sarah Garcia conducted an unannounced case management- incident visit in response to a self reported unusual incident report (LIC 624) received on 03/07/25 regarding possible children’s personal rights being violated. LPA met with licensee, Gloria Galvez. A walk through of the facility was conducted, and census was taken. Total census was 10 children and 2 staff.

A review of staff criminal clearance records on this date 04/08/2025 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 03/07/2025, a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported that on 3/07/2025 at approximately 8:50am, while children were playing inside and C1 took away blocks from another child and tripped over the toys, lost balance, and fell on their side. C1 could not lift his right arm and was unable to pick up a toy with their right arm. Parent was notified and C1 was picked up at 9:40am.

During today's inspection, LPA Garcia interviewed 2 staff and 2 children. LPA obtained facility roster, C1’s LIC 700, medical report, LIC 624, correspondence, and other relevant documentation.

Continued on Page 2

NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Sarah Garcia
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GALVEZ, GLORIA
FACILITY NUMBER: 304312729
VISIT DATE: 04/08/2025
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During staff interviews, Staff 1 (S1) stated, “...C1 was playing here in the living room, and C1 is very active…There were two kids playing there... C1 took the toys, and the other kids gave it to him. C1 was running, slipped, and fell on their arm. I immediately called licensing. C1 fell down on right arm. When C1 fell down, C1 fell on their arm.” S1 stated, “I sent a text to parent and immediately called licensing.” S1 stated the parent of C1 texted, “The doctor took an X-ray and didn’t see anything, and doctor bent the arm and fixed it. They said some pulled C1’s arm when C1 was running anyway now C1 can move their hand.” C1 returned to the facility on 03/10/2025.

LPA utilized Spanish translators ID #192 and #193 to interview Staff 2 (S2). S2 stated, “C1’s elbow hurt and C1 couldn’t bend their arm and my boss called child’s father to take them to the doctor to get their arm checked out.”

During children’s interviews, Child 1 (C1) stated they liked daycare. Child 2 (C2) was not qualified for an interview. Children made no disclosures regarding the incident.

LPA asked staff if they have observed or experienced any child being handled in a rough manner, 2 out of 2 staff stated they have not observed that.

Based on LPAs record review and interviews there was not enough evidence to determine violation of personal rights. No deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.



An exit interview conducted with licensee, Gloria Galvez. Notice of Site Visit was provided and must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.
NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Sarah Garcia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC809 (FAS) - (06/04)
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