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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007367
Report Date: 05/03/2019
Date Signed: 05/03/2019 01:33:31 PM

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:GATES FAMILY CHILD CAREFACILITY NUMBER:
198007367
ADMINISTRATOR:GATES, BERNETTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 608-3232
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: DATE:
05/03/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Bernetta Gates, LicenseeTIME COMPLETED:
01:50 PM
NARRATIVE
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Licensing Program Analysts (LPA's) Susann Sanchez and Raul Navarro conducted an unannounced random inspection to the above facility. LPA's met with Bernetta Gates, Licensee, who guided analysts on a tour of the facility. Also present during this inspection was Licensee’s Assistant and a volunteer. The licensee states that she currently has seven children enrolled and five children present. A current children’s roster is available and is current.

This is a two story home which consists of five bedrooms and two bathrooms. Areas used by the children are the garage (activity room), one bedroom (napping room), one bathroom, and the backyard (fenced). Per Licensee, areas off limits to children and parents include: five bedrooms, one bathroom, kitchen, dining room, living room, and front yard.

The licensee states that three adults and two child currently live in the home. Licensee states that she currently has a volunteer that comes only on Fridays 8- 12pm. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed home.

All areas identified on the facility sketch that children use were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central). The following was observed and reviewed during this inspection.

PHYSICAL PLANT
Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children and are kept in the laundry closet were it is inaccessible to children.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GATES FAMILY CHILD CARE
FACILITY NUMBER: 198007367
VISIT DATE: 05/03/2019
NARRATIVE
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Fireplaces and open face heaters are inaccessible to prevent access by children. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 04/12/2019, as indicated on the receipt . Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Smoke and carbon monoxide detector was tested and is in operable condition.

The licensee states that a cell phone is used and stays at the facility during operating hours. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play.

The licensee is observed to be operating within the license capacity limitations. The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 01/08/2020.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 04/2018.
PETS: Licensee has a small dog.
POSTING REQUIREMENT: Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted.
PROHIBITED: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.

Infant Care: Licensee states that she is currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GATES FAMILY CHILD CARE
FACILITY NUMBER: 198007367
VISIT DATE: 05/03/2019
NARRATIVE
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Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.govLPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices.



Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GATES FAMILY CHILD CARE
FACILITY NUMBER: 198007367
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2019
Section Cited
CCR
102417(g)(9)(A)(1)
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Operation of a Family Home
Each family child care home shall conduct fire drills and disaster drills at least once every six months. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
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Per Licensee, they will conduct a fire drill and submit a copy of log to LPA by POC date 05/17/2019.
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This requirement was not met by evidence during inspection it was founded that the last drill was conducted on 04/2018. This is a potential risk to the health and safety of the children in care.
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Type B
06/07/2019
Section Cited
HSC
1597.622(a)(1)
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Employee and Volunteer Immunization

Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and voluntee
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Per Licensee, they will submit proof of immunization against influenza, pertussis, and measles for herself, assistants, and her volunteers to LPA by POC date 06/07/2019.
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shall receive an influenza vaccination between August 1 and December 1 of each year.

Proof of immunization against influenza, pertussis, and measles for the Licensee and Assistants was not available.
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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: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4