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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407231
Report Date: 10/04/2023
Date Signed: 10/04/2023 03:13:22 PM


Document Has Been Signed on 10/04/2023 03:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 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: 4DATE:
10/04/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:48 AM
MET WITH:Veronica Gallegos - LicenseeTIME COMPLETED:
03:30 PM
NARRATIVE
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On 10/4/2023, Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced case management inspection for the purpose of citing for deficiencies observed during a complaint investigation for control #58-CC-20230621150457. Upon arrival, LPA was greeted by Licensee Veronica Gallegos and observed 4 children and 3 adults.

During the course of the investigation, it was confirmed that there were two adults in the home, Adult 1 and Adult 2, that do not have fingerprint clearance.

Additionally, It was confirmed that two separate incidents were not reported to the Department within 24 hours. No direct contact with the on duty worker was made within 24 hours.



LPA explained to the licensee that when an incident occurs, according to Title 22 Regulations, the incident must be reported to the department within 24 hours and a written report using the unusual incident /injury report LIC624B form must be filled out and mailed or emailed to the department within 7 days. Licensee understands and will comply.

The following two Type B deficiencies are being cited on 10/4/2023 in accordance to Title 22 of the California Code of Regulations: 102416.2 Reporting Requirements. (a)The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm).

The following two Type A deficiencies, are being cited on 10/4/2023 in accordance to Title 22 of the California Code of Regulations: 102370 Criminal Record Clearance (a)Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption.
SUPERVISOR'S NAME: Betty BellTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2023
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 197407231
VISIT DATE: 10/04/2023
NARRATIVE
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Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

Please refer to 809-D for cited deficiencies.

A copy of this report, notice of site visit, and appeal rights were provided. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with licensee, Veronica Gallegos.
SUPERVISOR'S NAME: Betty BellTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 10/04/2023 03:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 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: 10/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/18/2023
Section Cited
CCR
102370(a)

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102370 Criminal Record Clearance (a)Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption. This requirement is not met as evidenced by:
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Licensee agrees to obtain clearance or not allow Adult 1 into the home.
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Based on observations and interviews conducted and record review, A1 does not have fingerprint clearance , this poses an immediate risk to the health and safety of children in care.
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Type A
10/18/2023
Section Cited
CCR102370(a)

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102370 Criminal Record Clearance (a)Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption. This requirement is not met as evidenced by:
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Licensee agrees to obtain clearance or not allow Adult 2 into the home.
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Based on observations and interviews conducted and record review, A2 does not have fingerprint clearance , this poses an immediate risk to the health and safety of 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: Betty BellTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4


Document Has Been Signed on 10/04/2023 03:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 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: 10/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2023
Section Cited
CCR
102416.2(a)

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102416.2 Reporting Requirements (a)The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). This requirement is not met as evidenced by:
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Licensee agrees to:
(1) decleration acknowledging reporting requirements
(2) watch reporting requirements video and submit summary

https://ccld.childcarevideos.org/family-child-care-providers/child-care-reporting-requirements/
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Based on observations and interviews conducted, Licensee knew about the camera and failed to report to the department, this poses a potential risk to the health and safety of children in care.
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Licensee will submit proof of completion to LPA via email
suzette.ornelas@dss.ca.gov
Type B
10/18/2023
Section Cited
CCR102416.2(a)

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102416.2 Reporting Requirements (a)The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). This requirement is not met as evidenced by:
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Licensee agrees to:
(1) decleration acknowledging reporting requirements
(2) watch reporting requirements video and submit summary

https://ccld.childcarevideos.org/family-child-care-providers/child-care-reporting-requirements/

ONLY SUBMIT ONCE AS IT IS THE SAME POC AS ABOVE
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Based on observations and interviews conducted,Police went to home and licensee failed to notify the Department. On 06/21/23, two police officers accompanied County social workers to the residence to interview foster care children. Daycare children may have been present since licensee’s hours of operation are Monday through Saturday 24 hours, this poses a potential risk to the health and safety of children in care.
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Licensee will submit proof of completion to LPA via email
suzette.ornelas@dss.ca.gov
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: Betty BellTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4