414004470-11-8-2019-05-CC-MROZ-BHR3U3-20191108173252

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004470
Report Date: 11/08/2019
Date Signed: 11/08/2019 05:32:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	GALANT, GALINA		FACILITY NUMBER:	414004470
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	11/08/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Galina Galant		TIME 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	Licensing Program Analyst (LPA) Marie Rodriguez made an unannounced Annual Random inspection. LPA met with helper and explained purpose of inspection. Licensee Galina Galant was notified by phone and arrived a short time later. Licensee lives in a two story home with her two adult children, her two minor children, and a helper. Present in home were the Licensee, her minor son, a helper, and 5 children (preschool age). Licensee's adult son arrived a short time later. Licensee is operating within capacity requirements on this day. All adults living or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday from 7:30 am to 6:00 pm. Day Care Areas: Living room, dining room, bathroom #2, and backyard. Off Limit Areas: First floor: Kitchen, laundry room, bedroom #1, bedroom #2, bedroom #3, bathroom #1, garage, side yards, hot tub, and separate living space. Second floor: Whole entire second floor. LPA inspected day care areas of home with Licensee. LPA observed home to be clean and in good repair with proper temperature and ventilation. Per Licensee, there are no weapons or firearms in the home. There is a variety of age appropriate toys and equipment in the home and outside in the outdoor play area which are in good condition. Outdoor play area is fenced for supervision. There is a hot tub in the off limit area of the backyard that is covered and locked. Napping equipment is in good condition and properly stored. All cleaning supplies, poisons, and other chemicals are stored inaccessible to children. There is a working smoke detector and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone. Licensee has four dogs who are licensed and vaccinated but stay in the side yard and do not interact with the children. Eight children records reviewed were complete. All children have a record of emergency identification information on file. Licensee's record was reviewed and complete. Licensee's Pediatric First Aid/CPR certificate expires February 2020. Last emergency drill was conducted on October 3, 2019. Emergency drills are conducted every three months and are properly logged. (Continued on second page)

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019

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

FACILITY NAME: GALANT, GALINA	FACILITY NUMBER: 414004470
	VISIT DATE: 11/08/2019

NARRATIVE

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(Continued from first page)

Incidental Medical Services (IMS) was discussed. Licensee has no children who need services at this time. 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 Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

During inspection,

Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.
Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

No deficiencies cited today.

This report was reviewed and discussed with Licensee Galina Galant. A copy of report was provided.
Notice of site visit was observed being posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019

LIC809 (FAS) - (06/04)

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