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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408577
Report Date: 09/21/2022
Date Signed: 09/21/2022 11:55:09 AM


Document Has Been Signed on 09/21/2022 11:55 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:GAUT, CESYLIFACILITY NUMBER:
073408577
ADMINISTRATOR:GAUT, CESYLIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 451-4088
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:14CENSUS: 9DATE:
09/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cesyli GautTIME COMPLETED:
12:00 PM
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On 9/21/22 at 10:00 AM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced Annual inspection at Cesyli Gaut Family Childcare Home. LPA met with Cesyli and explained the purpose of today's inspection. LPA was granted the inspection authority to enter the Home. The family childcare home days and hours are Monday to Friday 8:00AM-2:30 PM. Present in the home at time of inspection were licensee, licensee's assistant, 2 preschool and 7 school-age children.

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

Indoor Space: A health and safety tour of inside the home was done. LPA toured the premises with licensee. The home is sanitized and orderly in compliance with Title 22 Regulations at this time. There is a 2A10BC fire extinguisher, working smoke and carbon monoxide detector in the home.



The OFF-LIMIT areas are the 2 bedrooms and 1 bathroom, laundry room, the office, and the kitchen. These areas are inaccessible to children in care by closed locked doors and visual supervision. IN-USE areas are: the day care room, dining area, bathroom located next to dining room, bedroom located next to dining and backyard area. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets with lock. LPA reminded licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Licensee states there are chickens and 1 dog. Licensee stated there no arms and ammunition stored in the home. The home maintains a working telephone.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: GAUT, CESYLI
FACILITY NUMBER: 073408577
VISIT DATE: 09/21/2022
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Outdoor Space: LPA toured the outdoor area (backyard) and observed it was fully fenced. LPA observed there are no pools, hot tubs or other bodies of water. Licensee stated that the primary area for child care is in the back yard since June 2020 due to COVID.

Children files and Facility files were reviewed. Facility contained Children's Roster, Licensee’s mandated reporter training expires 8/24, Pediatric CPR and first aid expires 9/23. LPa conduct staff interview.

This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

There were no deficiencies cited during today's inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Cesyli Gaut.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
LIC809 (FAS) - (06/04)
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