073408977-12-13-2023-02-CC-ILOA-CYH2ZH-20231213165022

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408977
Report Date: 12/13/2023
Date Signed: 12/13/2023 04:50:34 PM

Document Has Been Signed on 12/13/2023 04:50 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	GALVEZ, VERONICA		FACILITY NUMBER:	073408977
ADMINISTRATOR:	GALVEZ, VERONICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 307-6383
CITY:	SAN PABLO	STATE: CA	ZIP CODE:	94806
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	12/13/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Veronica Galvez		TIME COMPLETED:	05:00 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 December 13, 2023 at 1:55am Licensing Program Analyst (LPA) Indira Loza met with Licensee Veronica Galvez or the purpose of conducting an unannounced 3-year triennial inspection. Present during today's inspection were the Licensee, 4 preschoolers, and one infants. Residing in the home are the Licensee, her fingerprint cleared daughter-in-law, and two small dogs. The operating days and times are Monday - Friday 6am-6pm. The home was toured for a health and safety check. The home is a single family home consisting of three bedrooms, two bathrooms, kitchen, living room, dining area, garage, and fully fenced in backyard. On Limit Areas - The bedroom at the end of the hall and the first bedroom on the left from the hallway, living room, dining area, backyard, and bathroom in the hallway Off Limit Areas - The second bedroom on the left from the hallway with an attached bathroom, kitchen, and the garage. Licensee is reminded that all off limit areas are kept inaccessible through locked/closed doors, baby gates, and/or visual supervision. Isolation Area - is in the infant nap room The home has a fully charged 3A40BC fire extinguisher, a working smoke detector in the hallway, a working carbon monoxide detector in the hallway, and a working telephone. The Licensee stated she does not have Liability Insurance and has the Affidavit Regarding Liability Insurance in Family Child Care Home in all the children's files. The Licensee had a current Mandated Reporter Certificate which expires on March 20, 2025. The Licensee does not have a current CPR certificate which expired on August 2023. The home has heating and ventilation for safety and comfort. The Licensee has ample age-appropriate toys and learning materials in the home. Toxins, medicines, and hazardous items were inaccessible during today's inspection. There were no bodies of water present on the premises. Per the Licensee there are no firearms in the home. The ********************************Report Continues on LIC 809-C*****************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GALVEZ, VERONICA	FACILITY NUMBER: 073408977
	VISIT DATE: 12/13/2023

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
26
27
28
29
30
31
32

regarding the process or tools, please send them by email 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.

During the Exit Interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There was one Type B deficiency issued during today's visit.

Exit interview conducted and report was reviewed with Licensee Leticia Manzanarez.
Report and Appeal Rights were provided.
A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GALVEZ, VERONICA	FACILITY NUMBER: 073408977
	VISIT DATE: 12/13/2023

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
26
27
28
29
30
31
32

children's files were maintained and all were complete. backyard is fully fenced in and there were plenty of outdoor activities.

LPA reviewed three files and found that the infants were not logging in each 15 minute check during naps, naps, which is a Type B violation. LPA provided the Licensee with the Infant Safe Sleep Regulations and a copy of the "Individualized Safe Sleep Plan" (LIC 9227) was provided and reviewed. LPA assisted the Licensee with signing up to receive Provider Information Notifications (PINS).

Incidental Medical Services (IMS) policy was discussed. The Licensee is currently not providing IMS to the children in care. For IMS information see PIN 22-02. When any IMS is 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: http://www.ada.gov/childqanda.htm

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 onFamily 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.

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-and-resources/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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address **********************************Report Continues on LIC809-C********************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 12/13/2023 04:50 PM - It Cannot Be Edited

Created By: Indira Loza On 12/13/2023 at 03:43 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GALVEZ, VERONICA	FACILITY NUMBER: 073408977
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in due to the provider not documenting each 15 minute check and noting the following: Signs of distress which includes but is not limited to flushed skin color, increase in body temperature and restlessness, and labored breathing; which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/12/2024
	Plan of Correction
1 2 3 4	The Licensee shall begin documenting all the infant naps and send the LPA a copy of 5 consecutive days of sleep logs, which must be sent to the LPA no later than January 12, 2024.

Type B

Section Cited

CCR

102416(c)

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 interview and record review, the licensee did not comply with the section cited above in she did not have a current CPR certificate which expired on August 2023, this poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/12/2024
	Plan of Correction
1 2 3 4	The Licensee shall complete a CPR course and send the LPA a copy of the certificate no later than January 12, 2024.

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

SUPERVISOR'S NAME:

Mayla Mendoza

LICENSING EVALUATOR NAME:

Indira Loza

LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4