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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215794
Report Date: 06/04/2019
Date Signed: 06/04/2019 11:40:19 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GASTELUM FAMILY CHILD CAREFACILITY NUMBER:
566215794
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
06/04/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Marisol GastelumTIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPA) Michael Avila an announced visit for the purpose of conducting a Prelicensing Inspection. LPAs Avila met with Marisol Gastelum and discussed the nature and purpose of the visit. The home is a single story 3 bedroom house with two bathrooms a living room, kitchen, enclosed back and front yard and attached garage. The primary day-care will be conducted in the living room, one bathroom and the back and front yard. Applicant stated the garage and all of the bedrooms will be off limits and inaccessible to the children. CPR /First Aid is current with an expiration date of 04/11/2021. The Preventative Health & Safety Class has been completed. AB1207 Child Mandated Reporter Training Certificate was dated 06/03/2019. Cleaning items, sharp items and other items which could pose danger to children will be inaccessible to the children. Applicant states their is no firearms or ammunition in the home. Applicants stated no bodies of water in the property. Applicant provided a copy of the the rental agreement as proof of control of property. Applicant was made aware that it is his responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.cdss.ca.gov. Applicant was informed that baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours.
Incidental Medical Services (IMS) policy was discussed and handout provided. 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 and the ADA, available http://www.ada.gov/childqanda.htm
The applicant home meets the Title 22 Division 12 of California Code of Regulations. License to operate a Family Child Care Home is approved effective today.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019
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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