410518666-1-7-2025-05-CC-DALO-DCQ3TM-20250107173211

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410518666
Report Date: 01/07/2025
Date Signed: 01/07/2025 05:32:42 PM

Document Has Been Signed on 01/07/2025 05:32 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	GAMBLE, LILIA		FACILITY NUMBER:	410518666
ADMINISTRATOR/ DIRECTOR:	GAMBLE, LILIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 952-8490
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 4	DATE:	01/07/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:30 PM
MET WITH:	Samantha Gamble		TIME VISIT/ INSPECTION COMPLETED:	05:50 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 1/7/2025, at approximately 1:30PM, Licensing Program Analyst (LPA) Alvarado conducted an unannounced annual visit at the facility. LPA entered through the front entrance of the Home. LPA Alvarado met with Licensee’s Assistant Samantha Gamble (L1) and disclosed the purpose of the visit for today. Facility entrance is the first small gate on the right side of the home. Present in the Facility is (L1) supervising 4 children (preschool age). In the off-limit part of the home was Licensee Lilia Gamble and (L1) Husband. Everyone in the household has fingerprint clearance and are associated to the facility. Daycare area: Large Room on the First Floor, Bathroom, and the Front Enclosed Patio OFF limit area: Entire 2^nd floor, Kitchen in the Large Room in the Family Child Care Home, and Garage. LPA inspected the home for any health or safety hazards with (L1). LPA observed the home to be in clean and orderly condition. The home is equipped with a fully charged fire extinguisher. Facility has a smoke Detector and Carbon monoxide detector. Per (L1) there are no firearms present in the facility. At 3:10PM chemicals were observed in the bathroom under the sink with (L1). (L1) is aware and will put a safety lock on the sink cabinet to assure that the chemicals are not accessible. Facility uses their land line as the facility’s primary telephone and cell phones if needed. Phone number listed on file for Facility is current. Licensee and (L1) have a completed Mandated reporter training that is approved by the Department which expires 6/2025. Facility hours of operation are Monday-Friday 7:00AM-6:00PM. Facility has a dog that is located on the 2nd floor. LPA observed age-appropriate toys and learning materials to be present. Furniture is age-appropriate and free of rough, loose, or sharp edges. Facility provides Breakfast, Lunch and Snack. Continued on Page 2...

Ali Zebila	TELEPHONE: (650) 730-4140
Diana Alvarado	TELEPHONE: 650-266-8800
	DATE: 11/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GAMBLE, LILIA	FACILITY NUMBER: 410518666
	VISIT DATE: 01/07/2025

NARRATIVE

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Facility provided napping equipment such as matts and sheets and are washed at the end of the week. Facility last conducted an Emergency Drill on 10/17/24 and conducts them at least once every 6 months and properly logs them. Per (L1) home has a fireplace on the second level of the home where children do not have access to and is off limits.

There are no large bodies of water such as pools, wading pools, hot tubs, spas, fishponds and similar bodies of water in the facility. Facility (L1) was reminded that baby walkers, bouncers, jumpers, and any other similar items are to not be used for children in care.

LPA reviewed 4 children’s files, and facility records. Required postings were observed to be posted.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Diana Alvarado	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GAMBLE, LILIA	FACILITY NUMBER: 410518666
	VISIT DATE: 01/07/2025

NARRATIVE

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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-andresources/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 PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, (L1) confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

The deficiencies cited on the following pages are in violation of the California Code of Regulations, Title 22, Division 12, Chapter 1.

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SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Diana Alvarado	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GAMBLE, LILIA	FACILITY NUMBER: 410518666
	VISIT DATE: 01/07/2025

NARRATIVE

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See LIC 809-D for deficiencies cited today regarding Physical Plant, Facility Administration, and Records.
See LIC9102-TV for technical violation issued today regarding Physical Plant and Records.
See Technical Advisory in regard to Facility Administration.

Appeal rights were given and explained to the Licensee. A notice of site visit was given and must remain posted for 30 days. Licensee was reminded that a Notice of Site visit (LIC 9213) must be posted for 30 consecutive days during the hours of operation after each site visit by a licensing representative Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview conducted and report was reviewed with the Licensee’s Assistant, Samantha Gamble.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Diana Alvarado	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/07/2025 05:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GAMBLE, LILIA	FACILITY NUMBER: 410518666
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in one out of four persons, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/24/2025
	Plan of Correction
1 2 3 4	Facility will assure that all chemicals are locked and made inaccessible to children in care. Facility will put locks or clear out the cabinet with cleaning chemicls and make it inaccessible. Licnesee will submit an email with photosof proof to LPA Alvarado by 1/24/25.

Section Cited

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in one out of four persons, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/24/2025
	Plan of Correction
1 2 3 4	Licensee will ensure to register in a EMSA cerfied for CPR and First Aid. Licensee will submitt proof of enrollemt via email to LPA Alvarado by 1/24/25.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Ali Zebila	TELEPHONE: (650) 730-4140
Diana Alvarado	TELEPHONE: 650-266-8800
	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

LIC809 (FAS) - (06/04)

Page: 5 of 10

Document Has Been Signed on 01/07/2025 05:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GAMBLE, LILIA	FACILITY NUMBER: 410518666
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in one out of four, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/24/2025
	Plan of Correction
1 2 3 4	Facility will ensure to obtain a LIC 9040 that is present with the current children enrolled in the facility. Facility will maintain the children roster available for review. Licensee will submitt a copy via email to LPA Alvarado by 1/24/25.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Ali Zebila	TELEPHONE: (650) 730-4140
Diana Alvarado	TELEPHONE: 650-266-8800
	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

LIC809 (FAS) - (06/04)

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