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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376622788
Report Date: 01/22/2020
Date Signed: 01/22/2020 11:18:25 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GAITAN, TERESA FAMILY CHILD CAREFACILITY NUMBER:
376622788
ADMINISTRATOR:TERESA GAITANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 560-0104
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:14CENSUS: 7DATE:
01/22/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Teresa GaitanTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analysts (LPA) Elizabeth Rivera, made an unannounced annual/random inspection. Upon arrival LPA met with Teresa Gaitan and proceeded to tour the facility. During this inspection there were 7 children in care including 4 infants and her two assistants Martha Aispuro & Lourdes Escamilla. The facility is within licensed capacity/ratio limitations. Licensee stated there are no new adults living in the home over the age of 18 years.  A review of staff records on 5/14/18 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. Licensee has CPR/first aid certifications valid through 2/2021. The last fire and disaster drills were conducted and documented on 7/17/19.

The following areas are used for day-care: living room, dining room, family room, downstairs bathroom & backyard. Off limits areas are made inaccessible to day care children through the use of doorknob covers and safety gates. No bodies of water were observed during time of inspection. There is a working fire extinguisher rated 2A 10B:C, smoke and carbon monoxide detector are present and operational. LPA reviewed a sample of Children’s Records. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children through the use of cabinet latches and/or placed in off limit areas. Adequate heating and ventilation is provided for day-care children. Children’s toys, play equipment and materials are available. Licensee states there are NO firearms or weapons in the home. Licensee maintains a current facility roster of the children which LPA obtained during time of inspection.

LPA reviewed the following with licensee: SIDS, car seat law, reporting requirements and shaken baby syndrome. Licensee revised and updated facility personnel report to confirm all adult residents/helpers associated to the facility. LPA advised licensee that any new/additional adults must be cleared prior to working or residing in home. Licensee was also reminded the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care. 
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Elizabeth RiveraTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GAITAN, TERESA FAMILY CHILD CARE
FACILITY NUMBER: 376622788
VISIT DATE: 01/22/2020
NARRATIVE
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Licensee states she does not provide IMS to clients at this time. 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.html

LPA and Licensee discussed, Megan's Law, LPA provided: www.meganslaw.ca.gov.

You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website. Just go to www.ccld.ca.gov and click on Child Care, go under Quick Links and Quarterly Updates, click on “Receive Important Updates” then put the email address in and choose which program(s) you would like to subscribe to and click “subscribe.”

See LIC809D for issued deficiency.

LPA reviewed this report with licensee and an exit interview was conducted. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit. Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Elizabeth RiveraTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GAITAN, TERESA FAMILY CHILD CARE
FACILITY NUMBER: 376622788
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/24/2020
Section Cited

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102417 Operation of a Family Child Care Home (g)...Safety precautions shall include but not be limited to: (3)... stairs shall be fenced or barricaded. This regulation requirement was not met as evidenced by:
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LPA's observation of staircase without a safety gate. This poses a potential risk to children in care.
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Type B
01/31/2020
Section Cited

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(g) safety precautions shall include but not be limited to: (7)... parent's authorization for the licensee or registrant to consent to emergency medical care. This regulation was not met as evidenced by:
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LPA's observation while reviewing children's record. 3 children were missing LIC 627 Consent for Medical Treatment.
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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: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Elizabeth RiveraTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3