376629087-4-2-2021-20-CC-RGOU-BZPQ4M-20210402115035

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376629087
Report Date: 04/02/2021
Date Signed: 04/02/2021 11:50:53 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:	GALVEZ, MICHELLE FAMILY CHILDCARE		FACILITY NUMBER:	376629087
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	04/02/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Michelle Galvez		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 04/02/21 at 10:30 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an announced Pre-Licensing, change of location virtual tele-visit. Upon visit, LPA met with licensee, Michelle Galvez. Also, present in the home at time of inspection, licensees' two minor children. LPA proceeded to virtually tour this one story, three bedroom and one bathroom home to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3. Facility plans to operate from Monday through Sunday, 24 hours a day. All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children and poisons are to be locked away. The fire extinguisher, smoke and carbon monoxide detectors meet requirements and are operational. LPA observed required postings, including the COVID-19 postings posted. Children’s toys and play equipment are safe and age appropriate. There are no bodies of water observed by LPA during the inspection. LPA informed licensee to ensure children are supervised at all times during outdoor activities. There are no firearms or other weapons in the home, per licensee. Primary telephone is a cell phone which is operational. Pediatric CPR and First-Aid certificate are valid through May, 2022. There are no new adults living or working in the home. A review of clearances on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee rents the facility and has provided proof of control of property by a rental agreement, landlord consent is on file. Licensee has met the immunization requirements, per SB792 and has completed the AB1207 Mandated Reporter Training on 06/2020. LPA informed licensee the AB1207-Mandated Reporter training shall be completed once every two years. The 8-hr Preventative Health, including Lead Prevention certificate is on file and dated 06/2020. Facility self-certification and the COVID-facility self- assessment checklists are on file. See LIC809 continuation page…

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2021

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GALVEZ, MICHELLE FAMILY CHILDCARE	FACILITY NUMBER: 376629087
	VISIT DATE: 04/02/2021

NARRATIVE

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Licensee will use the following areas for childcare: Dining room, living room, kitchen, bathroom located in the hallway of the home and the backyard. Off limit areas of the home include: 3-bedrooms and the garage. The garage entrance from the backyard is made securely inaccessible by a key lock, per observation. All other off limit areas of the home are made securely inaccessible, per observation.

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 provided 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

LPA informed applicant in order to access CCLD-Childcare regulations, licensing forms, pay the annual fee to visit the following website: http://ccld.ca.gov. LPA discussed the following with licensee: to sign up for Quarterly Updates and PINs through the departments website. Please go to www.cdss.ca.gov and on the right side of your screen click on “Receive Important Updates”, put your email address in and choose which program(s) you would like to subscribe to and click “subscribe. In addition, for questions contact Child Care Licensing duty line at (619) 767-2248, Monday through Friday from 8:00 a.m. to 5:00 p.m. LPA discussed the following with licensee: lead poisoning effects brochure and information on SIDS and shake Mon baby syndrome, child abuse reporting, community resources, children’s records/facility records/required postings, immunization's, unusual incident report, roster, visual for ratio/capacity, prohibited items handout (walkers, exersaucers, jumpers and bouncy seats), emergency drill log example, and the YMCA Resource Center. LPA discussed California Megan's Law and provided the following to licensee with the following website: www.meganslaw.ca.gov.

LPA discussed the following with licensee: maximum capacity for a small family child care home: 4 infants only (infants mean any children under 24 months); or 6 children with no more than 3 infants; or (with landlord consent) 8 children with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home.

No corrections are needed. A small Family Child Care License will be issued after final file review. Once licensed the facility license will be emailed to the licensee. The following was discussed and will be provided to licensee via email: LIC809, LIC809-C reports and appeal rights. COVID-19 State of emergency read receipt notification will be used in place of licensee’s signature.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2021

LIC809 (FAS) - (06/04)

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