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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494589
Report Date: 10/05/2021
Date Signed: 10/05/2021 01:05:30 PM

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:
197494589
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
10/05/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Eliana GallegosTIME COMPLETED:
01:00 PM
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On October 5, 2021, Licensing Program Analyst (LPA) Veronica Wheatley conducted an announced in person case management inspection for an increase in capacity. LPA met with licensee and observed four children present today of one child is the licensee's minor child (2 infants present).

LPA Wheatley toured the entire inside and outside of the home. The home is a two bedrooms, one bathroom house with an attached converted garage used as a bedroom. The primary day care shall be conducted in the living room, kitchen and bathroom. The bedrooms are off-limits and there is a child proof gate to make the rooms inaccessible. LPA observed age appropriate toys, cubbies and equipment. The children's equipment will be kept separate and individual. LPA observed cots and first aid kit. LPA observed locks on the kitchen and bathroom cabinets which are required for chemicals, cleaning supplies, and any other hazardous items to children. LPA observed a large backyard with paved and grassy areas. The outdoor area is safe and there are no bodies of water. There are two dogs kept locked on the side of the home. The wall heater is properly screened.

LPA Wheatley observed the following:
*Fire safety requirements: Fully charged fire extinguisher (Classification: 2A10BC), smoke and carbon monoxide detectors present and operable. The licensee will conduct fire and earthquake drills.

Mandated Reporter Training is current expires September 2023. Children's records were reviewed and are current.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 197494589
VISIT DATE: 10/05/2021
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*Licensee currently certified in Pediatric CPR/First Aid and has completed the preventive health and safety training, and childhood nutrition training. Expires 7/17/23.
*Toys and equipment are observed and in good repair
* The home is equipped with a first-aid kit: Cleansing pads, band aid, bandages, gauze, and a digital thermometer
*Child proof electrical outlets were observed
*Licensee states there are no firearms on the premises.
*LPA Wheatley did not observe bodies of water

The following items were thoroughly discussed with the applicant:
*Covid-19 Guidelines in regards to check in and screening screening children upon arrival. Taking temperatures, washing hands for 20 seconds or longer with soap and water. Hand sanitizing stations for parents at entrance and available when children cannot was their hands. The hand sanitizer must be at lease 60% alcohol and kept inaccessible to the children in care.
*Requirements for fire drills, earthquake drills, and documentation for both
*The necessity of earthquake safety and drills twice a year
*The role and responsibilities of being a mandated reporter
*Mandatory Forms for the children’s files. Records must be kept for 3 years after termination.
*Licensee was referred to LIC 311D: Records to be Maintained at The Facility - Family Child Care Home.
*Licensee was made aware that it is their responsibility, as well as anyone who assists in providing care, to know Title 22 Regulations.
*The licensee was advised on how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov
*The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times. If the phone number has changed, licensing must be notified.
*Regulation prohibits the smoking of tobacco on the premises
*State law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: 197494589
VISIT DATE: 10/05/2021
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*Licensee was informed infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome) Licensee was informed that all provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials19-02 CCP Safe Sleep Awareness Campaign

*Only children eating may be in highchairs and that car seats are utilized only for transportation.


*Requirements for fingerprint clearances and associations are discussed with the licensee. The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day up to $500.00 (5 days) for the 1st offense and up to $3000.00 for the 2nd offense within a 12-month period.The applicant may find additional information and forms on the Department’s website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.
*LPA Wheatley informed licensee how to obtain Quarterly Updates. Applicant was encouraged to read the Child Care Quarterly updates every season, as they come out, to stay informed of any changes or updates to statutes and regulations. 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 and email address: childcareadvocatesprogram@dss.ca.gov
*The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and licensing within the time frame specified by the regulation (LIC 624B)
*The "Notification of Parent's Rights" (PUB394) poster must be posted in an area accessible to parents. *The applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days.
*LPA discussed AB633 and informed applicant that upon receipt of a Type A deficiency, the applicants shall post and provide copies of this licensing report (LIC 809 or LIC 9099 and copy of LIC 9224 parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 197494589
VISIT DATE: 10/05/2021
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Licensee states she does not have any children receiving IMS services.

*Incidental Medical Services (IMS) 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 Carrying out medical orders when the child’s physician has determined that a layperson can be trained and safely carry out the orders. Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted 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

*New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. *Applicant was informed of the following items that must be posted in visual site once licensed: (1) License (2) Emergency Disaster Plan (3) Children’s Roster (4) Parents Rights Poster PUB 394, Personal Rights LIC 613-A Recent regulatory changes were discussed.

A fire clearance was approved and received by the Los Angeles Fire Department.

A large license for 14 capacity will be granted when the following minor corrections are submitted within one week.

1. Cover the fire pit on patio, make inaccessible to children.


2. Remove paint containers out of the backyard.
3. The tree house is not in use however the lower part has a piece of wood to be removed.
4. Rose bushes or trees with thorns to be removed or fenced.

Exit interview. A copy of this report will be emailed to the licensee.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4