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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012194
Report Date: 07/15/2022
Date Signed: 07/15/2022 04:16:34 PM


Document Has Been Signed on 07/15/2022 04:16 PM - 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:GALLEGOS FAMILY CHILD CAREFACILITY NUMBER:
198012194
ADMINISTRATOR:GALLEGOS, IRMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 673-5979
CITY:LONG BEACHSTATE: CAZIP CODE:
90810
CAPACITY:14CENSUS: 16DATE:
07/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Maria Cortez Hernandez, AssistantTIME COMPLETED:
04:36 PM
NARRATIVE
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 THIS INSPECTION WAS CONDUCTED IN SPANISH

Licensing Program Analyst (LPA) Susann Sanchez, conducted an unannounced annual required inspection at the above facility on 07/15/2022 at 1:25 PM. LPA met with Maria Cortez Hernandez, Assistant who guided LPA a tour of the facility. Assistant informed LPA that a Licensee is out of the country due to an emergency. Also present was assistants Manuela Perez and Josefina Lopez. At end of tour, LPA Sanchez and assistant Hernandez did a tour of off- limit areas however, the master bedroom and the third bedroom were locked and assistant did not have keys to those rooms.

This is a one story home which consists of 4 bedrooms and 2 bathrooms. Areas used by children include 2 bedrooms, 2 bathrooms, living room with dining area, and backyard. Children only pass through the kitchen to access the back portion of the home. Per assistant Hernandez, areas off limits to children and parents include: 1 bedroom, front yard, and garage.

At 1:30 LPA observed that there were 16 children present. Of those 16 children there was 5 infants but unclear if there was more children under the age of 2. Assistants did not know the exact ages of the other children. Facility capacity is in not in compliance for a Large Family Child Care Home.

At 1:40 PM, LPA observed and photographed bedroom #2 where the door was closed and 2 infants where sleeping. An infant was sleeping in a FISHER PRICE Rock n Play sleeper, which have been recalled since 04/12/2019 by the United States Consumer Product Safety Commission. LPA did not observe and assistant Hernandez confirm that there are not any monitors/cameras and facility does not do the 15-minute sleep check documentation.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022
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: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 198012194
VISIT DATE: 07/15/2022
NARRATIVE
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At 1:55 PM, LPA toured the backyard and observed a broken window located high and out of reach of children.

At 2:00 PM, a parent with an infant arrived to the facility, LPA remind assistant that the facility is over capacity and they can no longer accept children.

Assistant told LPA that they do not know or have access of any licensing documents. LPA asked assistants if they have the phone numbers of the parents of any of the children present today 07/15/22, Assistant stated she only has the phone number of two parents. LPA documented the names of all the children and staff present.

At 3:30, there were 12 children and facility capacity is in compliance for a Large Family Child Care Home.

At 4:00, LPA reviewed and provided the PIN 20-24, a sample of an Infant Sleeping Log, and LIC 9227 Individual Infant Sleeping Plan.

Due to time constraints, unavailable documents, and licensee not present, LPA will return at a later date to complete annual inspection and issue Type B citations that were observed in areas evaluated today.

Based on the LPA’s observations, the following deficiencies listed on the attached LIC 809D (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.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

A notice of site visit was given and must remain posted for 30 days. Appeal rights were given in Spanish and was explained. Exit interview conducted and report was reviewed with the assistant Maria Cortez Hernandez.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/15/2022 04:16 PM - It Cannot Be Edited

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: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 198012194

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(a)(1)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (1) All cribs or play yards shall meet the United States Consumer Product Safety Commission safety standards.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed in bedroom#2 an infant sleeping in a FISHER PRICE Rock n Play sleeper, which have been recalled since 04/12/2019 by the United States Consumer Product Safety Commission, which poses an immediate personal rights risk to persons in care.
POC Due Date: 07/15/2022
Plan of Correction
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Assistant removed infant from the sleeper. Per assistant they will inform Licensee that the sleepers are recalled and are not allowed. LPA reviewed the safe sleep regulations with assistant. Assistant will call Licensee on 07/18/22 to see if she can throw away sleepers. LPA will follow up on 07/19/22.
Section Cited
Infant Safe Sleep
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4


Document Has Been Signed on 07/15/2022 04:16 PM - It Cannot Be Edited

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: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 198012194

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(j)(5)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Two infants were asleep in bedroom #2. The door was closed and there where no adults in the room watching the children. LPA did not observe any monitors and there was no documentation of assistant checking on the infants every 15 minutes. Which poses an immediate health, safety and personal rights risk to persons in care.
POC Due Date: 07/15/2022
Plan of Correction
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Per assistant, infants will continue to sleep in bedroom #2 with the bedroom open. Licensee will submit a sleeping plan for the infants. Plan is due 07/29/22.
Type A
Section Cited
CCR
102416.5(d)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Upon arrival, LPA observed 16 children present which poses an immediate safety risk to persons in care.
POC Due Date: 07/15/2022
Plan of Correction
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Per assistant, she will offer parents alternate schedules. Assistant will talk to Licensee as soon as possible to come up with a plan. If issue is not solved by next business day, facility will closed until a solution is found. LPA will follow on 07/19/22 by phone.

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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4