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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407231
Report Date: 02/11/2020
Date Signed: 02/11/2020 03:14:26 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:GALLEGOS FAMILY CHILD CAREFACILITY NUMBER:
197407231
ADMINISTRATOR:GALLEGOS, VERONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 626-9104
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:14CENSUS: 6DATE:
02/11/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Veronica GallegosTIME COMPLETED:
03:45 PM
NARRATIVE
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On 02/11/2020 at approximately 11:35 AM, Licensing Program Analyst, Stella Gutierrez met with Licensee, Veronica Gallegos and explained the purpose of todays visit of an annual required inspection to ensure that facility is in compliance with Title 22 regulations and Health and Health Safety code standards. Upon arrival, LPA observed 6 children (1 INFANTS and 4 TODDLERS and 1 PRE-SCHOOLER) being supervised by Staff #1. Facility is license for a capacity of 14 children. Facility is operating within ratio and capacity limitations. Upon arrival LPA was greeted by Staff #1 who was providing care and supervision for the children on his/her own today at the GALLEGOS FAMILY CHILD CARE. Staff #1 does not currently have an active criminal record clearance on file and is not associated to the facility. During the duration of the visit Licensee’s spouse (Spouse has a criminal record clearance and is associated to the facility) arrived to the facility at 12:15 PM and Licensee arrived at 12:25 PM. Licensee guided LPA on a tour of the facility inside and out. Hours of operation is 24 Hours 7 Days per week.

Areas identified in the sketch and observed by LPA, Gutierrez during today’s visit:
Interior:
This is a single-story dwelling, 5 bedrooms, 2 bathrooms with kitchen/dining, living room, Den and an attached garage. There are no weapons kept on the premises. The facility was inspected inside and outside for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning when compounds, and hazardous items that can pose a danger to children.

On limits areas include: Den area is where main care is provided for the children. LPA observed age appropriate toys, learning materials, games and activities for children in care. All furniture was found in good repair, clean, and without hazards. Bathroom #2 located to through main care area is utilized for the children in care. . LPA observed the bathroom to be in operable condition and free from hazards. Children nap and
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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
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 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 197407231
VISIT DATE: 02/11/2020
NARRATIVE
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sleep in main care area. LPA observed a table and chairs and high chairs for the kids to use when eating. Age appropriate napping equipment (COTS) materials available and inspected for the children. Changing table attached to wall. Informed Licensee to properly supervise infants when utilizing changing table. There is a door in between hallway and main care area making the rest of the home inaccessible to the children. Licensee’s room is through where main care is provided. Licensee keeps door shut and locked to make inaccessible to the children. Sliding glass doors are in children’s main care area to exit outside to back yard.
LPA observed a working smoke detector located in main play area l, an operable carbon monoxide detector located in main care area and 2A10-BC fire extinguisher in kitchen (Purchased in April 2019) and a fully equipped first aid kit including a digital thermometer located in kitchen.

Off-limits areas include the following: Kitchen, dining room, living room, all bedrooms. Cleaners/chemicals observed under kitchen sink with a latch and sharp objects in drawer with a lock.

Exterior:

On limits areas include: Back yard only, access to the back yard is through sliding glass doors from main play area. Inspection of the outdoor play area was conducted. Fencing around the perimeter of the back yard. LPA also observed a slide, a play house and several tyke toy bikes for the children to use while they are playing outside. LPA observed two heat lamps in back yard. . Licensee removed both heat lamps and placed in an inaccessible area (right side yard with gate door that locks) of the children when playing outside.

Off limits areas include: Guest home behind home with both adults living in home have obtained a criminal record clearance and is associated to the facility. There is no pool, spa or other bodies of water on the premises. The attached garage is through kitchen and door is kept shut during operating hours. Front yard and side yard to the right of home. LPA, observed that children do not have access to these areas.

Administration:

FORMS TO BE POSTED AND OBSERVED BY LPA during today’s visit in main play area


· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster Page 2 of 6
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
LIC809 (FAS) - (06/04)
Page: 2 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 197407231
VISIT DATE: 02/11/2020
NARRATIVE
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Children’s roster and fire drill log observed.
Licensee file and 6 children’s files were reviewed today.
-Pediatric First Aid and Adult, Child and Infant CPR to be current (expires on 03/02/2021) and for Staff #1 upon arrival (expires 04/06/2020)
-Preventative Health and Safety was not observed for Licensee or Staff #1 providing care today.
-No immunization records were observed for Licensee, Spouse or Staff #1 upon arrival today.
Mandated reporter Training certification was not observed today for Staff #1 that was providing care and supervision for the children in care upon arrival.

The following were also discussed with licensee:
LPA discussed capacity limitations, new car seat law, personal rights, Notification of Parent's Rights revised 12/06, inspection authority & agency's consultative role. Smoking is prohibited on the premises when children are present. The LPA also discussed earthquake safety and necessity of drills every 6 months. The applicant was also informed that all adults living in or having access to day care children in 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 $100 /day per uncleared adult will be assessed.

The facility is not currently providing IMS. Incidental Medical Services (IMS) policy was discussed with the Licensee. . 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.html

The licensee was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541.


Email Address: childcareadvocatesprogram@dss.ca.gov

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
LIC809 (FAS) - (06/04)
Page: 3 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 197407231
VISIT DATE: 02/11/2020
NARRATIVE
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Safe Sleep Links:
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

SIDS & SHAKEN BABY SYNDROME INFORMATION (discussed) flyer provided.


Licensee was reminded that all infants must be placed on their backs when sleeping . LPA provided safe sleep flyer and discussed safe sleep practice. Infants must be placed on their backs and must be physically checked every 15 minutes to gauge temperature and ensure they are breathing to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Licensee, Veronica Gallegos stated that she understands safe sleep practice and prevention of Shaken Baby Syndrome for infants and to ensure supervision at all times infants are in care at GALLEGOS FAMILY CHILD CARE facility.

Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.



New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. A copy provider rights and Appeal process provided to Licensee. All appeals must be sent to:

California Department of Social Services | Community Care Licensing Division
300 Continental Blvd., Suite 290-A
El Segundo, CA 90245

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint. Page 3 of 6
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
LIC809 (FAS) - (06/04)
Page: 4 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 197407231
VISIT DATE: 02/11/2020
NARRATIVE
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Assembly Bill 1207: California Child Care Workers; Mandated Training Requirement. Beginning January 1, 2018, all licensed providers, applicants, directors and employees must complete Mandated Reported Training prior to March 30, 2018 and renew training every two years at: www.mandatedreporterca.com. Volunteers are encouraged but not required to take the training. Providers are to complete the 4 hour General Training and 3 hour Child Care Provider Training. Licensee assistant upon arrival did not have proof of this requirement.

Nutrition Requirement: Beginning January 1, 2016, AB 290 will require for each new license issued, at least one director or teacher at each child care center or family child care home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program OR an accredited college or university.

Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.



Internet address for reports, regulations: DSSNET address: http://ccl.dss.cahwnet.gov/ and for children’s and employees forms: http://www.dss.cahwnet.gov/getinfo/pubintro.html#1

Licensee currently does not receive quarterly updates and will be registered by LPA. An updated email was received during today’s visit.





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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
LIC809 (FAS) - (06/04)
Page: 5 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 197407231
VISIT DATE: 02/11/2020
NARRATIVE
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The Facility was found to be not to be in substantial compliance per Title 22 regulations and Health and Safety Codes standards during today’s visit. Deficiencies will be cited today (See 809-D)

An exit interview was conducted and a copy of this report, appeal rights along with the notice of site visit were provided to Licensee, Veronia Gallegos.

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. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).














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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
LIC809 (FAS) - (06/04)
Page: 6 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 197407231
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/18/2020
Section Cited

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102370 Criminal Record Clearance, d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department,

Upon arrival LPA was greeted by Assistant, Staff #1 who was providing

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care and supervision on her own. LPA observed that Staff #1 was not associated to the facility. LPA, phoned the licensing office and later determined that Staff #1 does not have an active criminal record clearance.
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the process. LPA cleared this proof of correction and advsied Licensee until the Criminial Record Clearance is completed and cleared that Staff #1 cannot be present at the facility. However, there will be a civil penalty assessed today for the duration of 2 days that Licensee stated Staff #1 provided care at the facility between the dates of 02/04-02/11/2020.
Type B
02/18/2020
Section Cited

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1597.622 (a) (1) Employees or volunteers at family day care home; immunization requirements; records; exemptions. a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza,
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pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

Based on today's observation of records review this requirement was not met for Licensee, assistant or Staff #1.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2020
LIC809 (FAS) - (06/04)
Page: 7 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 197407231
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/18/2020
Section Cited

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102416 Personnel Requirements; (c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
Based of today's record review Licensee did not meet this requirement.
Type B
02/18/2020
Section Cited

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1596.8662 Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter...

Based on today's records review Staff #1 did not meet this requirement.
Type B
02/18/2020
Section Cited

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102418 immunizations; (a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

Based on today's review of children files, Licensee could not produce immunization requirement for Child #5 and Child #6.
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This poses an immediate health risk to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2020
LIC809 (FAS) - (06/04)
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