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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007023
Report Date: 09/16/2021
Date Signed: 09/17/2021 08:07:42 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GALVEZ FAMILY CHILD CAREFACILITY NUMBER:
198007023
ADMINISTRATOR:GALVEZ, CAROLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 229-2355
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 3DATE:
09/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Carol Galvez, LicenseeTIME COMPLETED:
12:15 PM
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An unannounced Required One Year Inspection was conducted by Licensing Program Analyst (LPA) A. Lucero. LPA met with licensee Carol Galvez who guided LPA on a tour of the facility. This is a two story, seven bedroom, three bathroom home. Adults residing in the home were discussed and noted. Present at the time of inspection was Licensee's Assistant #2 who was providing care and supervision to children in care.

Per Licensee areas accessible to children were inspected as follows: living room, den area that has been converted into a day care play area, dining area, one bathroom, back yard. Per licensee, areas off limits include: all bedrooms, two bathrooms, kitchen, part of the back yard that is fenced off and front yard.

Licensee states that there are no weapons or firearms on the premises. LPA did not observe any bodies of water or swimming pools on the property. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. Smoke and carbon detectors are present in the home and are operable.

Records review was conducted at around 10:30pm. LPA determined that the CPR/First Aid card provided was issued by the American Heart Association, states that it is Pediatric CPR/First Aid and expires 09/2022. Child Care Roster and Disaster Plan were reviewed. Children's Records were reviewed and discussed. LPA determined that Child #1 does not have immunization records. Required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement. Technical violations issued.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GALVEZ FAMILY CHILD CARE
FACILITY NUMBER: 198007023
VISIT DATE: 09/16/2021
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Carol Galvez.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
LIC809 (FAS) - (06/04)
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