197493495-5-31-2022-30-CC-MCON-CEXPFW-20220531111725

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493495
Report Date: 05/31/2022
Date Signed: 05/31/2022 11:19:44 AM

Document Has Been Signed on 05/31/2022 11:19 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	GILLIS FAMILY CHILD CARE		FACILITY NUMBER:	197493495
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	05/31/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Tracy Gillis, Licensee		TIME COMPLETED:	11:20 AM

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 May 31, 2022 at 09:45 AM, Licensing Program Analyst (LPA) Miriam Cohen conducted a case management inspection for the purpose of considering the facility for an increased capacity. Upon arrival, LPA Cohen met with Tracy Gillis, licensee, who guided analyst on a tour of the facility. All areas identified on the facility sketch were inspected. This is one-story home was inspected as follows: Living room, dining room, kitchen, four bedrooms, three bathrooms, front yard and backyard. Family members residing at facility are two adults. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The First Aid kit was observed in the pantry located in the hallway. Per applicant, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. There is hot tub located in the backyard, locked with a secure hook. There are age appropriate toys and equipment on the premises. The required fire extinguisher (2A 10BC) and smoke detectors are in operable condition. LPA observed licensee's current Pediatric CPR and Pediatric First Aid certificates. Applicant has submitted a disaster plan and demonstrated control of property which remains on file in the district office as initially licensed. LPA Cohen obtained an updated parent notification form to ensure the applicant is aware of her responsibility to notify parent if/when she is licensed at an increased capacity. Applicant used the affidavit regarding liability insurance. Areas off limits include: all bedrooms, living room, game room, dining room, kitchen, laundry room, and attached garage. Rooms/Areas were made inaccessible by doorknobs and safety gates. An approved Fire Clearance from the Fire Department was received. Licensee was made aware 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 childcare 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

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam Cohen	TELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GILLIS FAMILY CHILD CARE	FACILITY NUMBER: 197493495
	VISIT DATE: 05/31/2022

NARRATIVE

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Mandated Reporter: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com
Update on Incidental Medical Services: Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation 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
Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.
There are no corrections noted at the time of inspection.
A copy of this report was explained and issued to Tracy Gillis, licensee.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam Cohen	TELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

LIC809 (FAS) - (06/04)

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