013418370-10-19-2022-52-CC-AWRT-CKCQEM-20221019120634

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418370
Report Date: 10/19/2022
Date Signed: 10/19/2022 12:06:42 PM

Document Has Been Signed on 10/19/2022 12:06 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	GALLARDO, ADRIANA		FACILITY NUMBER:	013418370
ADMINISTRATOR:	GALLARDO, ADRIANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 938-7886
CITY:	FREMONT	STATE: CA	ZIP CODE:	94555
CAPACITY:	14	CENSUS: 2	DATE:	10/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Adriana Gallardo		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On Qctober 19th, 2022 @ 9:55am, Licensing Program Analyst (LPA) April Wright met with licensee Adriana Gallardo for an Unannounced Required 1 Year Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. There were two (2) preschool children present during inspection. Hours of operation are 8:30am - 5:30pm Monday through Friday. LPA toured the facility to conduct a health and safety inspection. The facility is a single-story home with 3 bedrooms and 2 bathrooms, a living room, family room, kitchen, attached 2-car garage front, side and back yards. Licensee uses additional space on the side of the home for the day care area. Separate space which consists of 2 large play/activity areas, a kitchenette, a bathroom and an enclosed small outdoor yard. Access to the day care area is to the left of the garage, which has its own separate gated entrance. On-limit-areas include: The day-care area on the side of the home consisting of the 2 large playrooms, kitchenette, bathroom, the small enclosed side yard and inside the main home in the family/TV room, that the children may use while supervised to watch a program. Off-limit-areas include: The main home and all 3 bedrooms and 2 bathrooms, the living room, kitchen, attached 2-car garage and back yard. All off limit areas are inaccessible by closed and/or locked doors and visual supervision. There are no pools hot tubs or any other bodies of water present in the on limit areas during todays inspection. LPA did not observe any hazardous materials or toxins accessible to children during today's inspection. There are ample age appropriate toys that appear to be safe and in good condition. See LIC809 -C for continuance

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April Wright	TELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GALLARDO, ADRIANA	FACILITY NUMBER: 013418370
	VISIT DATE: 10/19/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The home has a fully charged 3A40BC fire extinguisher, 3 working smoke/carbon monoxide detectors, fully stock First Aid Kit. and telephone. Per licensee there are no firearms in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers.

LPA requested and reviewed the files of two (2) children in care. The children's files contained, Parents rights, medical consent forms and identification and emergency contacts. The facility roster was review and copies were obtained. The licensee has not conducted fire and disaster drills as required. Last was conducted on 7/16/2021. The licensee has a current CPR/First aid which expires on 2/2024 and Mandated Reporter training was completed on 11/7/2021. The licensee is in ratio today. All required forms are posted and visible for public review.

Incidental Medical Services (IMS) policy was discussed. No IMS provided at this facility. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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: http://www.ada.gov/childqanda.htm

California Law requires Child Care Centers licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

The licensee is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

See LIC 809C for continuance

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April Wright	TELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GALLARDO, ADRIANA	FACILITY NUMBER: 013418370
	VISIT DATE: 10/19/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA discussed the Safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep web page https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a child care center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

There are no deficiencies cited today.

Please see below and attached advisory notes pages for additional information about technical violations issued today:

Technical Violation: Licensee has not conducted fire/disaster drills as required by licensing. Last conducted on 7/16/2021

A notice of site visit was given and must remain posted 30 days. Exit interview conducted and report was reviewed with Licensee Adriana Gallardo.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April Wright	TELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4