444406108-9-23-2020-07-CC-FCJO-BTQUMM-20200923154234

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444406108
Report Date: 09/18/2020
Date Signed: 09/23/2020 03:45:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	GALLO, ELEODORA		FACILITY NUMBER:	444406108
ADMINISTRATOR:	GALLO, ELEODORA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 722-6762
CITY:	FREEDOM	STATE: CA	ZIP CODE:	95019
CAPACITY:	14	CENSUS: 0	DATE:	09/18/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Eleodora Gallo		TIME COMPLETED:	03:00 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	Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an announced Case Management Tele Visit to the home today, with the purpose of reactivate the license. LPA contacted licensee Eleodora Gallo via WhatsApp. Days and hours of operation will be Monday to Sunday from 6:00 AM to 6:00 PM. The adults that reside in the home are the Licensee, her spouse Guadalupe, her sons Guadalupe and Mario, her daughter Angelica and her son in law Omar. Licensee stated also in her home reside minor grandchildren ages 13 and 10 years old. LPA observed there were not children in care during today's Tele Visit. Licensee's certifications for CPR and First Aid is current and will expire on 9/12/2022. LPA tele toured the indoor and outdoor areas of the home during today's Tele visit. The Licensee has a working telephone in the home. Licensee stated that off limit areas indoors are: 3 bedrooms, and the garage. Licensee stated that her daughter and her son in law live in the off limits garage. Off limit areas outside the home are two locked sheds in the back yard, and a studio which is a separate living area in the backyard where her two sons live. LPA observed there are not stairs in the home. LPA observed the home has a back yard and it is fenced. Licensee uses the back yard as playground. LPA observed a fully charged 2A10BC fire extinguisher last time serviced on December 2019, working smoke and carbon monoxide detectors and no bodies of water. The Licensee states that she does not have any weapons in the home. Licensee understands that all kind of detergents, cleaning compounds, medications, and other similar items must be stored inaccessible to children. LPA observed the home has a barricaded fireplace and licensee stated there are not wall heaters in the home. Licensee stated her daughter keeps a mid size dog in her living space in the garage. Licensee stated the dog is vaccinated. Licensee has submitted to this Department proof of having immunization for pertussis, measles, and influenza according with the SB792. ******************************Report dated 09/18/2020 continues in page 2.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2020

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GALLO, ELEODORA	FACILITY NUMBER: 444406108
	VISIT DATE: 09/18/2020

NARRATIVE

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Report dated 09/18/2020 continues from page 1.

A review of staff records on 09/15/2020 indicates that all the adults in the home or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
The Licensee understands her capacity options and she understand she cannot have more than 14 children in the home at any time.

Licensee states that she will not transport children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.

Department website: www.ccld.ca.gov provided to Licensee.

LPA informed the Licensee of the "mandated reporter" training is now available in Spanish. LPA advised licensee, and licensee understands the training is mandatory and licensee shall obtain proof of completion on or before December 31, 2020. Licensee understands deficiencies will be cited to licensees who do not obtain proof of compliance by December 31, 2020. LPA referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training.
LPA informed licensee about the new regulations on safe sleep for infant children. LPA referred the licensee to the Department website: www.ccld.ca.gov

One advisory note was given to Licensee today. The Tele visit was conducted with licensee in Spanish.

A NOTICE OF SITE VISIT WAS ISSUED AND ATTACHED TO THIS REPORT, MUST BE POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

Licensee understands that this report will be emailed to her and Licensee shall reply upon receiving it in lieu of her signature. Licensee understands her license will be reactivated only when LPA receives confirmation of licensee receiving this report.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2020

LIC809 (FAS) - (06/04)

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