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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372006511
Report Date: 01/27/2023
Date Signed: 01/27/2023 01:21:31 PM

Document Has Been Signed on 01/27/2023 01:21 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MAXWELL H. & MURIEL GLUCK CCC, LLC, THEFACILITY NUMBER:
372006511
ADMINISTRATOR:KRISTY FORDFACILITY TYPE:
850
ADDRESS:10660 JOHN J HOPKINS DRIVETELEPHONE:
(858) 455-5220
CITY:SAN DIEGOSTATE: CAZIP CODE:
92121
CAPACITY: 78TOTAL ENROLLED CHILDREN: 78CENSUS: DATE:
01/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Kristy FordTIME COMPLETED:
01:30 PM
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On 1/27/23 at 11:30 am LPA Annette Sutherland conducted a follow up on a self reported incident dated 11/7/22 involving a possible personal rights violation. LPA met with Director Kristy Ford and toured the facility. Appropriate ratios were observed. Staff were interviewed and records were reviewed. Based on information gathered there is not enough evidence to indicate that a violation occurred.


No deficiency will be cited for this incident as there does not appear to have been a violation of regulation.


Exit interview conducted and report was reviewed with the Director Kristy Ford. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2023
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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