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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153910076
Report Date: 05/22/2019
Date Signed: 05/22/2019 10:29:53 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:GIL, CAROLINA FAMILY CHILD CAREFACILITY NUMBER:
153910076
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
05/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Carolina GilTIME COMPLETED:
10:43 AM
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An unannounced annual inspection was conducted by Licensing Program Analyst (LPA) Angelica Ramirez and Suzanne Smith at 8:50 A.M. on 5/22/19. During the inspection, LPA met with licensee Carolina Gil. There are currently six (6) children enrolled in the family child care. Present during this inspection is licensee, spouse, licensee's biological child (age two) and three (3) child care children. Per licensee residing in the home on 5/22/19 is licensee, mother, spouse, tenant, and licensee's biological child (age two). This inspection is also conducted for a capacity increase, Fire Clearance has been received and granted for the large capacity (14).

Per licensee, the living room, dining room, one bathroom (located off hallway) and side yard are utilized for the family child care. Per licensee off-limit areas of the home are the kitchen, three bedrooms (one bath located in master) and attached garage (there is no access to the garage from inside the home).


Operating hours are Monday through Friday 5:00 AM to 5:00 PM. Licensee provides meals and snacks. The facility has a written emergency disaster plan and LPA observed a current roster.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children. LPA observed age appropriate safe toys and napping equipment (mats) on the premises. Per licensee children nap in the living room.



The facility annual fees are current. Licensee had all the required posted documents: Facility License (LIC 203), Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148). Children files were found to be complete. LPA observed the fire and earthquake drill log with most recent drill conducted on 5/22/19.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (661) 369-2168
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: GIL, CAROLINA FAMILY CHILD CARE
FACILITY NUMBER: 153910076
VISIT DATE: 05/22/2019
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Per licensee, there are no weapons or firearms on the premises. The side yard is used for outside play. The backyard is gated all around. The outdoor play area was inspected and was observed to be free of hazards, loose and sharp parts. LPA observed backyard appropriate safe toys.

LPA observed the required fire extinguisher (2A10BC) fully charged and meets fire marshal standards. Smoke detectors and carbon monoxide devices tested operable. The First Aid Kit was observed complete with supplies and first aid manual. LPA observed licensee has current Pediatric CPR and First Aid Training with expiration dated 02/16/21.

The following were discussed: There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present. Baby walkers, baby jumpers, baby exersaucers, baby bouncers/rockers and any other item that falls into that category are not permitted in the facility.

AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

Incidental Medical Services (IMS) were discussed. Per licensee, the facility is not currently providing IMS. LPA informed licensee to refer to IMS information in the 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.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (661) 369-2168
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: GIL, CAROLINA FAMILY CHILD CARE
FACILITY NUMBER: 153910076
VISIT DATE: 05/22/2019
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The licensee was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week.

The licensee was informed of the role and responsibilities of being a mandated reporter, renewal required every 2 years for a licensed child care provider, administrator, or employee ( www.mandatedreporterca.com ) Licensee completed on 4/13/18.

Child Care Advocates: To sign up for our Quarterly Updates please email the Child Care Advocates at childcareadvocatesprogram@dss.ca.gov & (916) 654-1541.



The licensee was reminded it is his/her responsibility to visit the departments website to obtain licensing forms, Quarterly Updates, and Provider Information Notices (PINs): www.ccld.ca.gov

A safe sleep flyer was provided to and discussed with the licensee.

LPA discussed requirements for an assistant, Licensee has an assistant and LPA observed the required documentation as well as a criminal record clearance (see LIC811). LPA advised licensee assistant is required to have current Pediatric First Aid/CPR at all times when present. LPA also discussed ratio and capacity requirements with licensee, LPA also provided ratio flyer.

Licensee is approved for a capacity increase as of today for a Large license with a capacity of 14.

The Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days.

Exit interview conducted with Licensee. A copy of this report, notice of site inspection, Confidential Names List (LIC 811) were given and explained during this inspection.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (661) 369-2168
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
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