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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153911290
Report Date: 07/13/2021
Date Signed: 07/13/2021 03:47:22 PM

Document Has Been Signed on 07/13/2021 03:47 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MORALES, GABRIELLE FAMILY CHILD CAREFACILITY NUMBER:
153911290
ADMINISTRATOR:MORALES, GABRIELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 532-6410
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
07/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Assistant, Diana MoralesTIME COMPLETED:
03:45 PM
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On 07/13/21 Licensing Program Analyst (LPA), Jose Penate conducted an unannounced Annual Required Inspection and was met by Assistant, Diana Morales. Licensee, Gabrielle Morales was not present at arrival to the home and after time passing licensee arrived and completed report with LPA. Planned hours of operation are Monday through Friday from 7:00AM - 5:00PM. This facility is licensed as a large facility of 14, there must be an additional qualified staff person present anytime the facility goes beyond the ratio for a capacity of eight.

LPA toured the home and a census was taken. Current facility sketch reviewed, and Licensee confirmed that hallway bathroom, daycare room, living room, kitchen, and dining room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by child spinner locks. There is no swimming pool or other bodies of water on the premises. There are no firearms and ammunition at this home. Poisons were observed under the sink in the kitchen during the inspection. Licensee does have one small size dog, one medium size dog and, one cat that will be inaccessible to day-care children. Licensee is aware of child safety around pets and accepts responsibility for any actions taken by pets.

There is a working fire extinguisher, smoke detector and carbon monoxide detector. The home has adequate heating and ventilation for safety and comfort. There are no stairs in this home. The home has working telephone service and LPA confirmed the phone number is (323) 532-6410.

There are two play pins for any future infants that will require care. Play pins are kept free from all loose articles and objects, and there are no objects hanging above or attached to the play yard. LPA discussed Safe Sleep regulations and required to physically check on sleeping infants every fifteen minutes and document any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Individual Infant Sleeping Plan was discussed for any future infants that may enroll, upon entry form LIC 9227 is required to be completed for each infant up to 0-12 months of age. Infants up to 12 months of age must be placed on their backs for sleeping.

Continued on LIC 809-C

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MORALES, GABRIELLE FAMILY CHILD CARE
FACILITY NUMBER: 153911290
VISIT DATE: 07/13/2021
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Assistant/Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained.

Licensee has a current roster of the children. Assistant has completed pediatric CPR/First Aid and will expire 5/26/2022. Mandated Reporter certification was not located by file or by email confirmation for self and licensee.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, deficiencies are cited (See LIC 809-D).

This report shall be made available to the public upon request.

LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Jose Penate
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021
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Document Has Been Signed on 07/13/2021 03:47 PM - It Cannot Be Edited


Created By: Jose Penate On 07/13/2021 at 02:42 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MORALES, GABRIELLE FAMILY CHILD CARE
FACILITY NUMBER: 153911290

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/13/2021
Section Cited
CCR
102417(g)(4)(A)

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Operation of a Family Child Care Home. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked. This requirement was not met as evidcenced by:
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Assistant removed poisons from underneath the kitchen sink and placed them in a locked area where children do not have access to. Deficiency cleared today: 7/13/2021
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Based on visiual observation,licensee did not ensure that poisons were kept locked. LPA observed 1 poison (insect/bug killer) that was underneath the sink in the kitchen that was not locked. This poses an immediate risk to the health, safety and personal rights of children in care.
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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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2021


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Document Has Been Signed on 07/13/2021 03:47 PM - It Cannot Be Edited


Created By: Jose Penate On 07/13/2021 at 02:33 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MORALES, GABRIELLE FAMILY CHILD CARE
FACILITY NUMBER: 153911290

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)

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Type B
07/30/2021
Section Cited
HSC1596.8662(b)(1)

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Mandated Reporter Training - On or before March 30, 2018..is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete and renew mandated reporter training every two years. from the initial mandated reporter training.
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Assistant agrees to complete the required Mandated Reporter Training and will submit proof to CCLD by the POC due date of 07/30/21. Licensee will also be
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This requirement was not met as evidenced by: Assistant was unable to provide Mandated Reporter Training for self and licensee. This posses a potential risk to the health, safety and/or personal rights of children in care.
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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:Duane Matsubara
LICENSING EVALUATOR NAME:Jose Penate
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2021


LIC809 (FAS) - (06/04)
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