304203092-5-9-2019-06-CC-THOO-BBZMBD-20190509092746

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304203092
Report Date: 05/09/2019
Date Signed: 05/09/2019 09:27:54 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	GABA, ROSE		FACILITY NUMBER:	304203092
ADMINISTRATOR:	GABA, ROSE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 890-3789
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92845
CAPACITY:	14	CENSUS: 12	DATE:	05/09/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Licensee Rose Gaba		TIME COMPLETED:	10:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Ho & Quinto and licensee toured the facility inside and outside. LPA observed 3 infants and 9 preschool age children playing in the day care area. The facility was within licensed capacity and the required ratio. Also, present assisting with the day care was licensee’s daughter, Noelle Gaba. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This is a two- story home with four bedrooms and 4 baths. LPAs observed a gate installed at the bottom of the stairs to prevent the children from accessing into the second floor. Licensee stated off limit areas include: all bedroom and upstairs. Licensee acknowledged that children may never enter these off-limit areas. Family members residing at facility are 4 adults and no children. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Per Licensee there are no weapons, firearms in the facility at this time. No *swimming pool, spa or other bodies of water observed on the premises. There are age appropriate toys and equipment on the premises. The required fire extinguisher (2A 10BC), carbon monoxide, and smoke detectors are in operable condition. Facility roster, disaster drill, and licensee’s required immunization (MMR, TDAP, FLU) were available for review. The licensee was reminded that must present at facility and ensure that children are properly cared for and supervised at all times. The licensee must make sure that a substitute adult cares for the children when licensee is temporarily absent. The licensee was also reminded that no child shall be left alone in a parked vehicle at any time. All day-care activities take place in the family room, dining room, the playroom, and the entry area. Children are able to have outside play in the enclosed backyard. Licensee and assistant are current with Pediatric CPR and First Aid and both valid until 7/2020. The licensee does not provide Incident Medical Services.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy Ho	TELEPHONE: (714) 703-2824
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GABA, ROSE	FACILITY NUMBER: 304203092
	VISIT DATE: 05/09/2019

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The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to presence in the facility. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, no infant walkers, No Johnny jumpers, no exersaucer or any other similar items that fall into that category are allowed in the facility. Disaster drills, posting requirements, children records, mandated child abuse and injury/ death reporting, and criminal records clearances/exemption transfer requests, SIDS and Never Shake a Baby.

After a tour of the home and review children and staff's records, no deficiency was observed.

During exit interview, “The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.” Notice of Site Visit was posted. Licensee was informed to keep the Notice of Site Visit posted for 30 days during the day care hours or $100 civil penalty will be assessed.

The facility representative was informed that the CRIMINAL RECORD STATEMENT (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182). The facility representative was informed that Licensing Updates are available at www.ccld.ca.gov

LPA reviewed with licensee the following safe sleep best practices:

· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot
or too cold.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy Ho	TELEPHONE: (714) 703-2824
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019

LIC809 (FAS) - (06/04)

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