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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312725
Report Date: 10/19/2021
Date Signed: 10/19/2021 12:58:39 PM

Document Has Been Signed on 10/19/2021 12:58 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GALVIN-REYES, COLLEENFACILITY NUMBER:
304312725
ADMINISTRATOR:GALVIN-REYES, COLLEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 466-7977
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
10/19/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Licensee, Colleen Galvin-ReyesTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Cindy Nguyen conducted a Plan of Correction (POC) inspection in response to two Type A violations issued on 10/11/2021. During the inspection on 10/11/2021, the facility was issued a type A violation for Staffing Ratio and Capacity. For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home and the assistant provider’s children under age 10, shall be either. The facility was also issued a type A violation for Operation of a Family Child Care Home (a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence.

During today’s inspection LPA observed 4 infants and 8 preschool age children that is being cared for by the licensee and an adult assistant, Bryna Dominguez. During today’s inspection the facility was operating within its licensed capacity and within compliance of staffing ratios. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance. Staff's and children's records were reviewed during today's inspection. In the areas reviewed the staff’s and children's files were found to be compliance.

There were no Title 22 deficiencies cited during today's inspection.

Exit interview was conducted with licensee Colleen, Galvin-Reyes. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Licensee was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2021
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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