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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628539
Report Date: 03/23/2022
Date Signed: 03/23/2022 02:51:48 PM


Document Has Been Signed on 03/23/2022 02:51 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:GAMBOA, MARIA FAMILY CHILD CAREFACILITY NUMBER:
376628539
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
03/23/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Maria GamboaTIME COMPLETED:
03:00 PM
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On March 23, at 1:40 PM, Licensing Program Analyst (LPA), Edgar Campana conducted an unannounced case management inspection with licensee, Maria Gamboa. LPA Campana informed licensee that the purpose of the inspection was for the requested change of capacity. Licensee led LPA on a tour of the facility. There were five (5) children present at the facility during the time of the inspection.
 
On 02/25/2022, a fire clearance was approved for 14 children. Licensee will use the following areas for child care: living room, downstairs bathroom, and backyard. The off limits areas are all made inaccessible via safety gates and door knob covers and are comprised of the following: kitchen, dining room and entire second floor. There were no bodies of water observed during time of inspection. There are sufficient age appropriate toys, games, and books available. The home was clean and orderly during inspection. The fire extinguisher is rated 2-A;10; BC, smoke alarm and carbon monoxide detector are operational. There is a working telephone in the home and all required forms are posted. Licensee stated that there are NO firearms or ammunition on the property. All adults living or working in the home have been fingerprint cleared and associated. LPA reviewed children's files and emergency drill log. Last fire/disaster drill was conducted on 03/23/2022. Pediatric CPR and First Aid certification expire 11/30/2023 . LPA discussed with Licensee the importance of maintaining supervision of day children at all times. LPA reviewed the following with licensee: SIDS, car seat law, reporting requirements, shaken baby syndrome, care and supervision, and COVID-19 precautions/guidelines. 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.

See LIC809-C for continuation...
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Edgar CampanaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2022
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 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: GAMBOA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376628539
VISIT DATE: 03/23/2022
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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.

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.

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

The maximum capacity for a large family child care home: 12 children (with a qualified assistant) with no more than 4 infants; or (with landlord consent) 14 children (with a qualified assistant) with no more than 3 infants, 1 child enrolled in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home. When there is no Qualified Assistant, 14 years of age or older present, the capacity reverts back to the requirements for a Small Family Child Care Home. To access our Regulations and Forms please use our WEBSITE: http://ccld.ca.gov.

Exit interview conducted and report was reviewed with the licensee, Maria Gamboa.

See LIC809-C for continuation...
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Edgar CampanaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022
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: GAMBOA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376628539
VISIT DATE: 03/23/2022
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A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A Regular Large Family Child Care Home license may be issued for 14 children upon final file review.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Edgar CampanaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3