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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020211
Report Date: 05/11/2022
Date Signed: 05/11/2022 02:39:58 PM


Document Has Been Signed on 05/11/2022 02:39 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:GARCIA GORDILLO FAMILY CHILD CAREFACILITY NUMBER:
198020211
ADMINISTRATOR:AURA GARCIA GORDILLOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
3235355149
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:14CENSUS: 8DATE:
05/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Aura Garcia GordilloTIME COMPLETED:
02:50 PM
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On 05/11/2022 Licensing Program Analysts (LPAs), Carolyn Tuba and Lissete Gonzalez conducted an unannounced Annual Required Inspection and was met by Licensee, Aura Garcia Gordillo. Also present was licensse’s husband, Jesus Gordillo. Hours of operation are currently: Monday-Friday 6 am to 6 pm. At 11:00 am LPAs toured the home inside and outside and a census was taken.

Areas accessible to children were inspected as follows: Living room, bathroom #2 located in the hallway and fenced backyard will be used for outdoor play. Dining area will be used for isolation area only.

Licensee provided an updated indoor facility sketch and all 3 bedrooms and all other rooms are off-limits and made inaccessible by use of child safety gates. LPAs did not observed a swimming pool or other bodies of water on the premises. Per licensee there are no firearms or ammunition on the premises and no poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible inside a child-proof lock in the cabinet located by bathroom #2. Licensee has a First Aid kit available.
The valve on the required 2A 10 BC fire extinguisher indicates fully charged and was serviced on 4/2022, as indicated on the service tag. Smoke detector, carbon monoxide detector were tested and are operable. There is adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPAs confirmed the phone number is (323) 535-5149.
There are currently 3 infants in care. LPAs discussed Safe Sleep Regulations with licensee. LPAs observed sleeping mats available for children in care. There are currently 2 back-n-play for infants in care and are kept free from all loose articles and objects, while infants are sleeping, and there are no objects hanging above or attached to the play yard. Infants are not swaddled while in care. Per Licensee states that she will begin physical checks for sleeping infants on this date, 5/11/2022 every fifteen minutes and document any signs of distress, which includes, but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. LPAs advised Individual Infant Sleeping Plan is to be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2022
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 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GARCIA GORDILLO FAMILY CHILD CARE
FACILITY NUMBER: 198020211
VISIT DATE: 05/11/2022
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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained on this date, 5/11/2022.
LPAs reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 04/22/2022. Licensee’s pediatric CPR/First Aid expires on 04/24/2023. Per file review records indicates that all licensee’s husband have immunization records on file for influenza, pertussis and measles.
All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.
Incidental Medical Services (IMS) are not currently being provided. Licensee 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.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.
Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

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.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GARCIA GORDILLO FAMILY CHILD CARE
FACILITY NUMBER: 198020211
VISIT DATE: 05/11/2022
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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.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Aura Garcia Gordillo.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3