• Type A

  102370.1(b)(2) · 102370.1(b)(2) Criminal Record Exemptions: Provide a copy of the Addendum to Notification of Parent's Rights (Regarding Removal/Exclusion) (LIC 995B Rev. 05/03) to one parent or authorized representative of every child currently in care within one day of receipt of the addendum from the Department.

  Licensee will ensure enrolled families sign the LIC995B, regarding individual's removal by the due date: 6/17/2026. Proof of correction will be submitted to the Department via email. At 2:30PM. Based on interview and record review, LPA confirmed LIC995B, Family Child Care Home Addendum to Notification of Parents Rights Regarding Removal was missing from the children's files. This poses an immediate health and safety risk to children in care. Civil Penalty of $1000.00 dollars was issued to facility. Marie Rodriguez NAME OF LICENSING PROGRAM MANAGER: Luis Gomez NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/16/2026 I acknowledge receipt of this form and understand my appeal rights as explained and received.

  Open Not marked corrected in the state record

  Category: background checks. Open / not marked corrected.

• Type B

  102370(d) · 102370(d) Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility

Disposition: Unsubstantiated