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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334806572
Report Date: 03/17/2022
Date Signed: 03/17/2022 02:54:27 PM


Document Has Been Signed on 03/17/2022 02:54 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:GALVEZ-BOOTH FAMILY CHILD CAREFACILITY NUMBER:
334806572
ADMINISTRATOR:GALVEZ-BOOTH, LETICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 564-7597
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY:14CENSUS: 9DATE:
03/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Leticia Galvez-Booth, LicenseeTIME COMPLETED:
03:30 PM
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On the date and time listed, Licensing Program Analyst (LPA) Nasha King arrived at the facility to conduct an annual inspection as part of a compliance review. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed:

· Normal days and hours of operation are: Monday-Friday 7:30 AM – 5:00 PM (Verified on 03/17/2022)

· Off-limit areas include: Entire right side of the home (right side= when walking through the front door entrance) (Verified on 03/17/2022)

· The facility is operating within the licensed capacity and appropriate ratios (Verified on 03/17/2022)


· Appropriate supervision provided during this inspection (Verified on 03/17/2022)

· A working telephone is present and the current number is on file (Verified on 03/17/2022)

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector present and were tested by the Licensee during this inspection. (Verified on 03/17/2022)

· Fireplace is properly screened to prevent access by children (N/A-there is no fireplace) (Verified on 03/17/2022)

· All hazardous items are stored inaccessible to children (Verified on 03/17/2022)

· Toxins are locked (Verified on 03/17/2022)

· There are no weapons present in the home. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations. (Verified on 03/17/2022)

· Stairs are barricaded (N/A- single story home) (Verified on 03/17/2022)

SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Nasha KingTELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
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 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: GALVEZ-BOOTH FAMILY CHILD CARE
FACILITY NUMBER: 334806572
VISIT DATE: 03/17/2022
NARRATIVE
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· Clean, safe and age appropriate toys (Verified on 03/17/2022)

· Current roster on file (Verified on 03/17/2022)

· Facility Sketch, Emergency Disaster Plan and Notification of Parent’s Rights poster are posted (Verified on 03/17/2022)

· Documentation of fire and disaster drills on file – Last drill conducted on 03/17/2022 (Verified on 03/17/2022)

· No bodies of water at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position. (Verified on 03/17/2022)

· Verification of control of property on file (Verified on 03/17/2022)

· Children’s records are complete (Verified on 03/17/2022)

· Employee’s records is not complete (Verified on 03/17/2022)

· Mandated Reporter Training completed (Licensee has not taken this training)

· Pediatric CPR and First Aid Card expired on August 2021. (Verified on 03/17/2022)

· Health & Safety Certificate - completed on (Licensee has not taken this training)


· Resident and/or staff records were reviewed and all adults who require caregiver background checks have received all required clearances and/or exemptions. (Verified on 03/17/2022)

The licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

The Licensee was informed of their reporting requirements and was provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov.

SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Nasha KingTELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: GALVEZ-BOOTH FAMILY CHILD CARE
FACILITY NUMBER: 334806572
VISIT DATE: 03/17/2022
NARRATIVE
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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.


The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage 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.

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.

Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.



The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.

See LIC809-D for cited deficiencies.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Nasha KingTELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: GALVEZ-BOOTH FAMILY CHILD CARE
FACILITY NUMBER: 334806572
VISIT DATE: 03/17/2022
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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.

An exit interview was conducted, and this report was reviewed with the Licensee, Leticia Galvez-Booth. Appeal rights were discussed and provided during the exit interview.



A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Nasha KingTELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 03/17/2022 02:54 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: GALVEZ-BOOTH FAMILY CHILD CARE
FACILITY NUMBER: 334806572

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's record review, the licensee did not comply with the section cited as the Licensee has not been keeping a sleep log for C1. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/15/2022
Plan of Correction
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The Licensee has agreed to submit a completed LIC 9227 for C1 to LPA King on or before the POC due date (04/15/2022). Licensee has also agreed to comply with PIN 20-24 CCP and will maintain an infant sleep log, documenting all 15-minute checks for infants in care. Licensee will submit proof via email to nasha.king@dss.ca.gov.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, the licensee did not comply with the section cited above, as the Licensee's CPR/First Aid Certification expired on August 2021. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/15/2022
Plan of Correction
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The Licensee has agreed to enroll in the CPR/First Aid course and provide proof of completion to LPA King on or before the POC due date (04/15/2022). Licensee will submit proof via email to nasha.king@dss.ca.gov.

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: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Nasha KingTELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5