153910076-3-30-2022-12-CC-EROZ-CCZKUY-20220330081332

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153910076
Report Date: 03/29/2022
Date Signed: 03/30/2022 08:13:37 AM

Document Has Been Signed on 03/30/2022 08:13 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	GIL, CAROLINA FAMILY CHILD CARE		FACILITY NUMBER:	153910076
ADMINISTRATOR:	GIL, CAROLINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 699-9135
CITY:	LAMONT	STATE: CA	ZIP CODE:	93241
CAPACITY:	14	CENSUS: 3	DATE:	03/29/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	12:38 PM
MET WITH:	Carolina Gil		TIME COMPLETED:	01:59 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 03/29/22 at 12:38 p.m. Licensing Program Analysts (LPA) Esequiel Rodriguez conducted an unannounced Case Management inspection at the Family Child Care Home Facility for the purpose of following up and see how they are doing on their current operation of Facility's program, and physical plant status. Also, to provide technical assistance as deem necessary in order for the Child Care Home to continue to meet compliance with California Code of Regulations (CCR) Title 22, Health and Safety requirements, and other applicable State and Licensing Statutory requirements. Also, to follow up with the Licensee regarding the importance of being aware of the Community Care Licensing Division's (CCLD) inspection tools, known as the Compliance and Regulatory Enforcement (CARE) Tools that were developed under the Department's (IPP) Inspection Process Project. The LPA met Licensee, Carolina Gil and stated the purpose for the inspection as stated above. The facility license is posted on a prominent place of the Center. Currently there are three children in care. The Licensee provided copy of the Family Child Care Home children roster (LIC 9040), and List of Personnel associated to the Facility. LPA provided copy of Personnel Report, LIC 500 to the licensee and explained its purpose. LPA explained that the CARE Tools are now used by Licensing Program Analysts (LPAs) when conducting inspections in licensed facilities. The CARE Tools focus CCLD’s efforts in three IPP priority areas: Prevention, Compliance and Enforcement. The CARE Tools for Child Care Centers evaluates, but not limited to, the following licensing domains: • Physical Plant: Furniture, toys, flooring, cleanliness, etc. • Care and Supervision: Protecting children in care; monitoring food intake or special diets; assistance in

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GIL, CAROLINA FAMILY CHILD CARE	FACILITY NUMBER: 153910076
	VISIT DATE: 03/29/2022

NARRATIVE

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LPA Rodriguez along with the Licensee. conducted an overall visual assessment of the inside and outside the Center's physical plant. The Center is clean, safe, sanitary and well maintain. All utilities are operational and in good order. There is plenty parking space. The first aid kit is present and complete and is inaccessible to children/infants. The fire extinguishers, smoke alarms and carbon monoxide monitors are in compliance and fully operational. The Licensee conducts and records emergency disaster drills.

The LPA advise Ms. Gil to ensure the parent board is always current with the latest information available, as applicable, and not limited to: Child Passenger Restraint System poster (PUB 269) Notification of Parent's Rights; (PUB 394) Emergency Disaster Plan (LIC 610A) Earthquake Preparedness form (LIC 9148) LIC Personal Rights, (613A) and is posted in an area accessible to parents. LPA advise Licensee to ensure every one working at the Facility is current with all required training, and properly qualified to provide quality care and safe supervision to children in care.

Regarding COVID-19, the LPA told the Licensee that providers should continue to follow COVID-19 requirements and guidance in all applicable CDSS Providers Information Notices (PINs) and All County Information Notices (ACINs), in addition to guidance or instructions from health care providers, Centers for Disease Control and Prevention (CDC), CDPH, Department of Developmental Services (DDS), Cal/OSHA, and local public health departments, as applicable to the particular facility or home category. If there are differing requirements between the most current CDC, CDPH, CDSS, DDS, Cal/OSHA, and local health department guidance or health orders, licensees and providers should follow the strictest requirements. Also the LPA provided copy of PIN 22-02-CCP regarding Best Practices to the Provision of Incidental Medical Services IMS.

During today's inspection the LPA observed no deficiencies that may hinder the health and safety of the children in care. Therefore, no deficiencies were cited.

An exit Interview was conducted and a copy of this Report and notice of site visit (LIC 9213) was provided to the Ms. Gil.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GIL, CAROLINA FAMILY CHILD CARE	FACILITY NUMBER: 153910076
	VISIT DATE: 03/29/2022

NARRATIVE

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diapering, toileting, dressing, and other personal hygiene needs; taking medication; etc.

• Facility Administration and Records: Documentation, files upkeep (children and staff) providers experience, qualifications, criminal record clearances and exemptions, training, general information applicable to staff, medical needs, immunization's, individual development plans, food service (if provided) Reporting requirements (reporting incidents)

• Records: documentation related to immunization, emergency contact information, etc.

• Staffing Ratio and Capacity: Staffing ratios per number of children in care.

• Personal Rights: Children's personal rights.

Reporting Requirements (not on CARE tool, but can also be inspected) Reporting incidents, etc.

The LPA provided a copy of the Facility Entrance Checklist (LIC 126) and explain that the Licensee and assistances shall be familiar with these forms and ensure they are implemented as needed to ensure the Family Child Care Home Facility's file is current and up-to-date.

The LPA encouraged the Licensee to become familiar with the Guardian Background Check Program and CARE Tools inspection processes by periodically visiting the Child Care Program (CCP) section of the CCLD Inspection Process Project Website at www.ccl.ca.gov and
https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process
The page is updated regularly and contains the new tools and related documents that can be downloaded. Ms. Gil acknowledged.

The LPA informed Licensee that although, the Child Care Facility Roster form (LIC 9040) and Personnel Report (LIC 500) and the Records to be Maintain at the Facility listing (LIC 311D) are not listed on the LIC 125, these forms shall be maintained up-to-date and available.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

LIC809 (FAS) - (06/04)

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