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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625406
Report Date: 11/25/2019
Date Signed: 11/25/2019 04:27:00 PM

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:GIL-CERVANTES, SANDRA FAMILY CHILD CAREFACILITY NUMBER:
376625406
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
11/25/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Sandra Gil-CervantesTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA), Selina Siao conducted an announced capacity increase. The 4 bedroom, 2 bath one story house was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Licensee stated that there are no bodies of water or weapons in the home. A review of staff records on this date indicates that licensee is currently the only adult resident in the home and has the required background clearances. Licensee owns the home and therefore can care for up to 14 children. The home appears to be large enough to comfortably accommodate 14 children when there is a qualified helper. Fire clearance was received on 10/22/2019. Licensee's First Aid and CPR certifications are current due to expire on April 2021.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include living room, kitchen, dining area, room #1 (day care play room) and room #2 (day care napping room). Off limits areas include the back bathroom, bedroom #3 and bedroom #4. The home has sufficient toys and equipment available. Licensee states that she takes the children to the nearby playground for outdoor activities.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2019
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 2
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: GIL-CERVANTES, SANDRA FAMILY CHILD CARE
FACILITY NUMBER: 376625406
VISIT DATE: 11/25/2019
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The following handouts were provided to the licensee today:
  • PIN 19-10-CCP – U.S. Consumer Product Safety Commission recall
  • PIN 19-09-CCP – Head Lice Information for Child Care Providers
  • Health & Human Services Agency Guidance on Head Lice Prevention and Control
  • PIN 19-08-CCP – CA Department of Public Health New Pre-Kindergarten Immunization requirements
  • PIN 19-06-CCP – U.S. Consumer Product Safety Commission recall
  • PIN 19-02-CCP – Safe Sleep Awareness Campaign


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

The facility appears to be in substantial compliance. No corrections are needed, a license for 14 will be issued effective today.


Notice of Site Visit was posted and it must be remained posted for 30 days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2