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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610649
Report Date: 12/13/2023
Date Signed: 12/13/2023 12:27:21 PM

Document Has Been Signed on 12/13/2023 12:27 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 DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GAXIOLA-GASTELUM, CAROLINA FAMILY CHILD CAREFACILITY NUMBER:
136610649
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/13/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Licensee, Carolilna Gaxiola-GastelumTIME COMPLETED:
12:30 PM
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On 12/13/2023 at 10:20am, Licensing Program Analyst (LPA) Daniela Huerta conducted an announced pre-licensing inspection with applicant, Carolina Gaxiola-Gastelum. The purpose of the inspection is to ensure the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. The one story, four (4) bedroom, two (2) bathroom apartment was toured and inspected. Days and hours of operation are Monday through Friday, 5:00am - 4:00am.

Applicant will utilize the following areas for childcare: living room, dining room, patio, bathroom #1 and kitchen. Off limit areas include bedroom #1 through #4, and bathroom #2. Off limits areas are inaccessible to children by use of doorknob covers, safety latches and baby gates. Applicant will utilize patio and complex playground for outdoor activities. LPA informed applicant to ensure that children are always supervised during outdoor activities.

The fire extinguisher is rated 2A-:10-B:C and located in the kitchen. The smoke and carbon monoxide detectors meet requirements and are operational. Poisons, detergents, cleaning compounds, medications and other hazardous items were made inaccessible to children by cabinet locks/latches. There is no fireplace in the home. Applicant has children's toys, play equipment and books available. The applicant has a working cell phone. Applicant stated there are no firearms or other weapons in the home.


Applicant provided proof of control of property. Applicant maintains documentation of proof of control of property for review by the Department. Property Owner/Landlord Consent form LIC9149 is on file, signed by landlord and approves licensee to care for eight (8) children. Applicant’s Mandated Reporter AB1207 training expires on 6/15/25. Applicant completed 8 hours of preventative health which included nutrition and lead training on 8/12/23. Pediatric CPR and First Aid certifications expire on 06/25. Immunization records per SB792 were reviewed and met regulations. Required documents are posted.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Daniela Huerta
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)
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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 DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GAXIOLA-GASTELUM, CAROLINA FAMILY CHILD CARE
FACILITY NUMBER: 136610649
VISIT DATE: 12/13/2023
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Applicant and adult residents in the home have criminal record clearances and/or exemptions on file. Applicant 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.

On this date, 10/02/23, the California Attorney General - Megan’s Law website (meganslaw.ca.gov) was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

LPA discussed 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. 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 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Daniela Huerta
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)
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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 DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GAXIOLA-GASTELUM, CAROLINA FAMILY CHILD CARE
FACILITY NUMBER: 136610649
VISIT DATE: 12/13/2023
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The Provider Resource Packet was reviewed with the applicant including information on the following: PIN 20-24-CCP Safe Sleep Regulations, lead exposure, SIDS, shaken baby, child abuse reporting, community resources, children’s records, facility records, required postings, immunization, unusual incident report, facility roster, car seat law, visual for ratio/capacity, fire/disaster drill log. Applicant was also informed the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care.


The Applicant states she is financially secure to operate a family childcare home for children. The Applicant agrees to comply with all regulations and laws governing family childcare homes.

Applicant was advised that an agent of the Licensing Department upon presentation of proper identification, may enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice. The Applicant shall permit the Department to inspect the family childcare home, and to privately interview children or staff, to determine compliance with or to prevent violations of family childcare laws or regulations. Applicant was advised that the Department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation, if the Applicant refuses any agent of the licensing Department entry into the daycare or any part of the daycare.

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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Daniela Huerta
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)
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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 DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GAXIOLA-GASTELUM, CAROLINA FAMILY CHILD CARE
FACILITY NUMBER: 136610649
VISIT DATE: 12/13/2023
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LPA review the ratio/capacity worksheet with applicant. LPA discussed the maximum capacity for a small family child care home: four infants only (infants mean any children under 24 months); or six children with no more than three infants; or, with landlord consent, eight children with no more than two infants, one child in kindergarten or elementary school and one child at least age six, including children under age 10 who live in the home

To improve the quality and value of the new inspection process, a survey will 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 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/process


A Regular Small Family Child Care Home license may be issued upon final review. LPA Huerta explained inspection report to applicant, applicant stated she understood. Exit interview conducted and report was reviewed with the applicant, Carolina Gaxiola-Gastelum.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Daniela Huerta
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)
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