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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494921
Report Date: 10/26/2021
Date Signed: 10/26/2021 11:20:38 AM

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:GABOUREL FAMILY CHILD CAREFACILITY NUMBER:
197494921
ADMINISTRATOR:CRYSTAL GABOURELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 253-0136
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:14CENSUS: 0DATE:
10/26/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Crystal Gabourel, ApplicantTIME COMPLETED:
11:30 AM
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On 10/26/2021 at 10:00am, Licensing Program Analyst (LPA), Adrian Risher conducted a pre-licensing inspection for a family child care home change of location. LPA met with applicant Crystal Gabourel and toured the facility. The applicant and her grandaughter are the only individuals present at the time of the inspection. The home is clean, orderly and comfortable. All adults in the home have been fingerprinted and associated to the facility. The hours of operation will be 23 hours Sunday thru Saturday. Applicant is requesting to have a family child care home with a capacity of 14. The fire clearance was approved on 09/17/2021 by Marshall Gregory Hoerner

The home is 5 bedroom and 2 bathroom duplex. The daycare will consist of the living room, Bedroom 1, Bedroom 3 and the garage. These areas were inspected by LPA. The other bedrooms and rooms are considered off-limits and inaccessible. Applicant will place safety handles on the bedrooms that are off limits. Applicant owns the home. The parents will enter home from the front entrance or the gate in the front yard. Applicant stated that the living room will be used for eating, napping or daily activities. Bedroom 1 will be used for napping or eating. Bedroom 3 will be used for napping if needed. The garage will be used for daily activities, napping and eating if weather permits. Applicant will use cots for napping. LPA inspected the bathroom and did not observe any medications or poisons that could pose a potential risk to children in care. The kitchen was inspected during the visit. LPA did not observe any knives or sharp objects, detergents or cleaning supplies that would pose a potential risk to children in care. These items were made inaccessible to the children. Licensee has put safety locks on the lower cabinets in the kitchen and also has a safety gate at the entrance of the other side of the duplex. Bedroom 3 will be used as the isolation area for ill children.

LPA observed age appropriate toys, furniture and activities for children while in care at the facility. LPA observed play equipment and toys in the outside play area. There is no body of water.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
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: GABOUREL FAMILY CHILD CARE
FACILITY NUMBER: 197494921
VISIT DATE: 10/26/2021
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LPA observed a charged fire extinguisher (2-A:10-B:C). LPA tested the smoke detector and carbon monoxide detector. Applicant has a first aid kit which includes band aids and a thermometer. The home has central heat and air.Applicant has current CPR, first aid, health and safety which expires 03/2023 Per the applicant, there are no firearms on the premises. Applicant reports that there are no pets in the home. The parent board will be posted for parents to view required information such as the license, parent's rights poster, personal rights, and emergency disaster plan. A copy of the children's roster will be kept accessible.

Applicant provided copies of immunization records and mandated reporter training has been reviewed and completed.


The following corrections were discussed with applicant in order for the home to be ready for conducting child care:

1. safety handles on doors(applicant will send picture)

A license to operate a Large Family child care home will be reviewed following final administrative review, and receipt of outstanding corrections needed. No license will be issued today . Applicant will notify LPA when corrections have been made, and the Applicant has 30days to complete corrections.

Exit interview and copy of report provided. Appeal rights have been reviewed and provided.

LPA discussed Safe Sleep Regulations with the Applicant

Incidental Medical Services (IMS) will be provided. Applicant is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: GABOUREL FAMILY CHILD CARE
FACILITY NUMBER: 197494921
VISIT DATE: 10/26/2021
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Applicant was made aware that once licensed, it is the licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Applicant was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Applicant was also encouraged to read the Child Care quarterly updates to remain informed of any changes or updates to the Regulations.

Applicant 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 child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as follows: Phone Number (916) 654-1541 and Email Address: childcareadvocatesprogram@dss.ca.gov

Applicant agrees to operate the family child care home in a way to reflect a home-like environment and agrees to the following per Children’s Personal Rights Title 22 Regulation(s): 102423 (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (1) To be treated with dignity in his/her personal relationship with staff and other persons. (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. (3) To have parents or guardians informed by the licensee of the provisions of the law regarding complaints and the procedures for registering complaints confidentially, including, but not limited to the address and telephone number of the licensing agency's complaint unit. (4) To be free from corporal or unusual punishment, 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.

Applicant was reminded of their responsibility to report suspected child abuse. Mandated Reporter Training is required and needs to be renewed every 2 years.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC809 (FAS) - (06/04)
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