367700215-9-18-2021-12-CC-JDOY-C6YP8P-20210918110553

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700215
Report Date: 09/18/2021
Date Signed: 09/18/2021 11:06:28 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	GALVAN FAMILY CHILD CARE		FACILITY NUMBER:	367700215
ADMINISTRATOR:	MAGDALENA GALVAN, AGRIPINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 552-2914
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92392
CAPACITY:	14	CENSUS: 0	DATE:	09/18/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Magdalena Galvan and Agripina Gomez		TIME COMPLETED:	11:20 AM

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Licensing Program Analyst (LPA) Justin Dorsey conducted an announced visit with Applicant Magdalena Galvan and Agprina Gomez who guided analyst on a tour of the home for a Pre licensing Inspection. This is a one story home with 5 bedrooms, 2 bathrooms, kitchen, dining area, family room (converted to play area), living room, and laundry room. There is no pool/or body of water on the premises. Family members residing in the home include four adults (Applicants and 2 other adults) and three children. Days/hours of operation will be Monday through Friday from 6:00 AM to 6:00 PM.

Physical Plant: Home is clean and orderly, the home has a fire place that is inaccessible to children in care, LPA observed age appropriate toys and play equipment, working smoke detector and carbon monoxide detector, and fully charged 2A10BC Fire Extinguisher. Per licensee no one smokes in the home. There is a designated area for ill child(ren) as necessary, no weapon/firearms, facility sketch complete and current, off limit areas include all of the homes bedrooms, 1 bathrooms, kitchen and laundry room. The laundry room is made inaccessible by a door with a safety lock on the knob. There is a working telephone (cell phone), poisons and cleaning items inaccessible (under the sink) to children.

Kitchen/bathroom: The following are inaccessible: Sharp items, medications, and chemicals are inaccessible. Toilets and faucets are clean and operable.

Outdoor: LPA observed the homes backyard. The backyard includes a concrete and grass area for children to play. LPA observed a swing set and a slide on the grass area of the back yard for children to play. LPA observed the backyard toys and equipment to be in good condition. The backyard includes a dirt area on the right side of the backyard, at the moment this area is off-limits. Per applicant Galvan she may put a fence to restrict children's access to this area. There is a gated off-limits area on the left side of the backyard, LPA observed a barbecue in this area. LPA did not observe any items that could be hazardous to children in care.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GALVAN FAMILY CHILD CARE	FACILITY NUMBER: 367700215
	VISIT DATE: 09/18/2021

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Advisory/Other: First Aid kit readily available. CPR/First Aid expires 10/2022 for both applicants. The electrical outlets are covered. Per licensee the children will nap in the living room. Per licensee she purchased 12 cots for children to nap. Applicant reminded to supervise children at all times.

Pets: Per Applicant Galvin there is 1 cat in the home. LPA did not observe any other pets during the pre-licensing inspection.

LPA advised Applicant All adults living/residing in the home are fingerprint cleared and associated.

Documents Provided and or Discussed: The following were discussed regarding Title 22 requirements: Safe Sleep and Large Family Child Care Home Ratios

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

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; Applicant reminded that 100% supervision is required at all times to children in care; Applicant made aware that it is her/their responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

Applicant advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GALVAN FAMILY CHILD CARE	FACILITY NUMBER: 367700215
	VISIT DATE: 09/18/2021

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Applicant advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

Corrections needed before application can be submitted for approval:

1.) The applicants will place a barricade around the AC unit in the backyard to make it inaccessible to children in care.
2.) Applicants will send a picture of the cots when they arrive to the home.

Exit interview conducted and a copy of this report was given to Applicants Magdalena Galvan and Agripina Gomez.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2021

LIC809 (FAS) - (06/04)

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