153910076-5-25-2022-12-CC-EROZ-CERM8R-20220525092333

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153910076
Report Date: 05/23/2022
Date Signed: 05/25/2022 09:23:51 AM

Document Has Been Signed on 05/25/2022 09:23 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: 4	DATE:	05/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Carolina Gil		TIME COMPLETED:	12:32 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 05/23/22 at 09:31 a..m. Licensing Program Analysts (LPA) Esequiel Rodriguez conducted an unannounced annual inspection at the Family Child Care Home to assess the Facility operation of their program and current physical plant status. Also, to evaluate the Facility's continuing ability to meet compliance with California Code of Regulations (CCR) Title 22, Health and Safety requirements, and other applicable State and Licensing Statutory requirements. LPA Rodriguez met with Licensee, Carolina Gil and stated the reason for the inspection. The LPA provided a copy of the Entrance checklist form, LIC 126. LPA Rodriguez told provider that to better assure and promote the health and safety of each individual being cared for in licensed setting, the Community Care Licensing Division's (CCLD) is focusing efforts on three priority areas: Prevention, compliance, and enforcement; Therefore, CCLD launched the Inspection Process Project (IPP) to meet these goals. As a result it developed the Compliance and Regulatory Enforcement (CARE) Tools for the Child Care Program which is being used during today's inspection. These does not impose any new requirement on the provider. At 10:05 p.m. LPA Rodriguez along with the Licensee conducted a walk trough of the inside and outside of the facility along with the entire operation of the Facility. The Facility license is posted on a prominent place of the facility. The home is licensed to provide day care services to 14 children. All of the play yards or playpens used by the facility are made of material (mesh or fabric) that has not been banned or recalled by the United States Consumer Product Safety Commission. The home is clean, safe and orderly, with heating and ventilation for safety and comfort. The home maintain telephone service (Licensee was advised the cell phone shall be charged and available during day care hours.) The facility has safe age appropriate toys, play equipment and materials for the children care to use. There are no fixtures, furniture, and/or equipment that have been banned or recalled by the United States Consumer Product Safety Commission present or accessible to children at the facility at the time of this inspection. Per

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

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: 05/23/2022

NARRATIVE

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Per Licensee, she is present in the home during child care time and ensure all children in care are supervised at all times. When circumstances requires her to be temporarily absent from the home, she arranges for a substitute adult to care for and supervise the children during her absence. Per Licensee, her temporary absences does not exceed 20 percent of the hours that the facility is providing care per day. Licensee states that when a child shows signs of illness he/she shall be separated from other children, and the nature of the illness is determined. If it is a communicable disease he/she shall be separated from other children until the infectious stage is over.

Licensee stated that when infants are in care, no infant is forced to sleep, to stay awake, or forced to stay in the designated sleeping area. The infants are not swaddled while in care, are not covered while sleeping, and car seats are only used for transportation purposes, and never be used to put any child on the seat to sleeping, and if an infant falls asleep before being placed in a crib or play yard, the infant is immediately placed in his/her crib or play yard. She said all infants, while sleeping, are supervised and provide physically checks every 15 minutes (check for Labored breathing, any sign of distress, flushed skin color, increase in body temperature and restlessness, etc) Licensee said, she ensures infants up to 12 month of age who are sleeping, are in a position other than on their back, and she or her assistant position themselves near enough to the sleeping infant(s) to be able to hear them wake up. If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in open at all times, and the licensee is .able to visually observe the infant without moving the door.

The licensee and assistants have complete or renewed their mandated reporter training and are current with their required immunization or exemptions from immunization. The Licensee and other persons associated to the facility have obtained appropriate clearance or a criminal record exemption as required by the Department.
The licensee and assistant(s) have completed training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid. Records Licensee and assistant have been immunized against influenza, pertussis, and measles.

Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 day of incident on the form LIC624B

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

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: 05/23/2022

NARRATIVE

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per the regulation. The report unusual incident/injuries report should be emailed to
nusualIncidentReport@dss.ca.gov

Personnel records are maintained on each employee and contain the following information:
Licensee and staff full name. A signed and dated copy of the Notice of Employee Rights [LIC 9052,] A signed statement regarding their criminal record history, LIC 508. Driver's license number if the employee is to transport children. Date of employment. Date of birth. Current home address and phone number. Documentation of completion of training on preventative health practices as required by Section 102416(c). All personnel records are maintained at the facility. Any change to the facility from an area of the family child care home previously. Licensee and assistant(s) have been immunized against influenza, pertussis, and measles. Licensee and and other adults living in the home or working at the facility have received crimnal record clearance and association.

There is an emergency information card maintained for each child in care, including the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. Per Licensee, prior to admission the children are immunized with required vaccines, and it documents on each child's record. The immunization record is maintain such documentation for as long as the child is enrolled. The record maintain to keep track of immunization is the PM 286. Copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A; the Caregiver Background Check Process, LIC 995E, and the Family child Care Consumer Awareness Information, LIC 9212 are provided to the parents. The licensee maintain, in each child's record, the signed and dated notice form required, including, a copy of an emergency information card.

Licensee is aware that a in the child’s record, a copy of documentation verifying the child’s enrollment and attendance at kindergarten, including transitional kindergarten, or elementary school. The facility has a current roster of children. Children records contain the bottom portion of the, signed and dated, notice form LIC 995A.,There is proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC995E, and the Family Child Care Consumer

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

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: 05/23/2022

NARRATIVE

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LPA encouraged licensee to become familiar with the CARE Tools and inspection processes by periodically visiting the Inspection Process Project and CARE Tools Website. The page will be updated regularly with information related to the new tools and related documents:
https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Overall, the Facility is in compliance per Title 22 regulations. 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, Children's Record Review form (LIC 857) Review of Staff Records form (LIC 859) Advisory Notes-Technical Advisory (LIC 9102) and Notice of Site Visit (IC 9213) were provided to Ms. Gil.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

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: 05/23/2022

NARRATIVE

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Awareness Information, LIC 9212. PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster is posted and the parents have been informed that the Facility does not carry liability insurance or a bond according to standards established by the state.

At the time of acceptance of each child into care, the licensee child's parent or authorized representative receive a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A, the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

Licensee stated that she is present in the home all the time when children are present, and ensure the children are properly supervised at all times. Licensee stated that facility does not provides transportation for day care children. Licensee is aware of the capacity stated on the facility license. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, is as follows: (1) Twelve children, no more than four of whom may be infants; or (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.

Per Licensee, each child receiving services at the Facility are treated with dignity and respect. They are provided with safe, healthful, and comfortable accommodations, furnishings, and equipment. There is no corporal or unusual punishment of any kind, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

The LPA informed the provider that CCLD will continue to evaluate and research the effects and efficiency of the new inspection tools. To implement this continuous quality improvement process, CCLD requests that licensees participate in a short survey relating to their experiences with the CARE tool. The licensee was told that she may receive a link to the survey after each completed inspection. Participation is voluntary, and all responses will be kept confidential.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

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: 05/23/2022

NARRATIVE

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Licensee, if food is brought from the children's homes, the container is labeled with the child's name and properly stored or refrigerated.

The facility is free from defects or conditions which might endanger a child. The fireplace and open face heaters are properly screened to prevent access by children. The facility has an operational carbon monoxide detector and fire extinguisher which meet established standards. Stairs to second floor of the facility is properly fenced or barricaded. Poisons, detergents, cleaning compounds, medicines, firearms (no fire arms at this facility) and other items which could pose a danger if readily available to children are stored where they are locked and inaccessible to children. The facility has * a written disaster plan of action prepared. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, have been instructed in their duties under the disaster plan. Newly enrolled children are informed promptly of their duties as required in the emergency plan. Fire drills and disaster drills are conducted at least once every six months and/or more often, the licensee document the drills, including the date and time of each drill. There are no baby walkers in the facility.

Smoking is prohibited on the premises of a family child care home. There is one crib or play yard for each infant who is unable to climb out of the crib or play yard. The crib(s) or play yards use by the facility meet the United States Consumer Product Safety Commission safety standards. Placement of crib(s or play yards do not hinder entrance or exit to/and from the space where infants sleep. Mattresses are firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. The mattresses are made specifically for the size crib or play yard in which they are placed.

Per Licensee, fitted sheets are immediately replaced when wet or soiled, and each infant's bedding is used for him/her only. Bedding that touches the infant’s skin are cleaned weekly or before use by another infant. Soiled bedding is placed in a closed container and made inaccessible to infants until washed. Cribs or play yards are free from all loose articles and objects. Pacifiers are allowed in the crib or play yard as long as there is nothing attached to the pacifier, and it is specific to the infant it is being given to. Bumper pads are not permitted and there are no objects hanging above or attached to the side of the crib(s). The Facility does not have any bodies of water. The outdoor play areas are properly fenced and supervised by the licensee.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

LIC809 (FAS) - (06/04)

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