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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020741
Report Date: 03/21/2022
Date Signed: 03/21/2022 06:34:47 PM

Document Has Been Signed on 03/21/2022 06:34 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GALLARDO FAMILY CHILD CAREFACILITY NUMBER:
198020741
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 10CENSUS: 9DATE:
03/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Gabriela Gallardo TIME COMPLETED:
06:45 PM
NARRATIVE
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At 3:30 pm Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced required 1 year inspection to the above facility. A risk assessment was conducted upon entry- appropriate PPE was used. LPA met with Gabriela Gallardo, Licensee who guided analysts on a tour of the facility. Per Licensee, there are currently 10 children enrolled. A current children’s roster was available for review. There were 9 children present upon arrival- 3 being infants. The licensee was observed no to be operating within the license capacity limitations. During inspection licensee called parents and C1 was picked up at 4:25pm. This poses and immediate risk to the health and safety of children in care. Also present during this inspection were two assistants.

The licensee states that 1 adult and 1 child currently live in the home. Per Licensee, they currently have 3 assistants. At 3:40 pm during the inspection LPA observed that Staff # 1 Sylvana Gallardo, Assistant is not fingerprint cleared and or associated to the facility. LPA called the Regional Office and determined through Licensing Information System (LIS) and Guardian that Assistant Sylvana Gallardo is not fingerprinted and or associated to the facility. Per Licensee, Assistant has been working has been employed with the facility since 5/3/2021. This poses and immediate risk to the health and safety of children in care. A civil penalty of $500 was assessed on this day.

This is a one story home which consists of 3 bedrooms, 2 restrooms, living room, family room, kitchen, garage and backyard (fenced). The children have access to living room, family room, kitchen, one bedroom and backyard fenced. Per Licensee, the children used potties and their hands are washed in the kitchen.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2022
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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Document Has Been Signed on 03/21/2022 06:34 PM - It Cannot Be Edited


Created By: Roxana Lopez On 03/21/2022 at 05:13 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GALLARDO FAMILY CHILD CARE
FACILITY NUMBER: 198020741

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and interviews, the licensee did not comply with the section cited above in that Staff Sylvana Gallardo is not fingerprint cleared or associated to the facility.which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/21/2022
Plan of Correction
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During inspections Licensee had assistant Sylvana leave the facility to get fingerprinted. Once fingerprint clear Licensee will submit proof of documentation..
Type A
Section Cited
CCR
102416.5(c)
Staffing Ratio and Capacity
(c) The total licensed capacity for a Small Family Child Care Home shall not exceed eight children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interviews, the licensee did not comply with the section cited above in C1 was the 9th child present in the facility which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/21/2022
Plan of Correction
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During inspection Licensee called parents of C1- C1 was picked up at 4:25 pm. Per Licensee, she will write a declation stating plan for facility to be in compliance.
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:Brandi VanOosten
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/21/2022 06:34 PM - It Cannot Be Edited


Created By: Roxana Lopez On 03/21/2022 at 05:13 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GALLARDO FAMILY CHILD CARE
FACILITY NUMBER: 198020741

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above in that the require A-102BC Fire extinguisher was last serviced on 1/20/2021 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2022
Plan of Correction
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Per Licensee she will buy a new fire extinguiser and submit proof to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Brandi VanOosten
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2022


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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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GALLARDO FAMILY CHILD CARE
FACILITY NUMBER: 198020741
VISIT DATE: 03/21/2022
NARRATIVE
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 Per licensee, areas off limits to children and parents, 2 bedrooms, 2 bathrooms, garage and front yard.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a landline and a cellphone that stays at the facility during operation hours. There is ventilation and heating (central). The following was observed and reviewed during this inspection.

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Per Licensee there are no poisons in the facility.

LPA Lopez did observed a fireplace in the family room which was barricaded and inaccessible for children in care. The valve on the required 2A10BC fire extinguisher was last service on 1/20/2021, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 2/10/2021

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the entry hallway.

The home is observed to be clean and orderly. There are toys available for children. Appropriate sleeping arrangements and cribs were observed.

Licensee states that they are currently caring for infants. LPA discussed the safe sleep regulations with licensee [or facility representative] 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.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022
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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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GALLARDO FAMILY CHILD CARE
FACILITY NUMBER: 198020741
VISIT DATE: 03/21/2022
NARRATIVE
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 LPA also informed licensee Gabriela Gallardo 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.

LPA did observe a jumper in the living room and a trampoline in the back yard. Per Licensee, she will remove these items and submit pictures to LPA.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA observed a wooden play structure- LPA advised licensee that structure should be sanded and painted to prevent any splinters.

There are no pets on the premises.

At 5:00 pm children’s records were reviewed, including emergency information and were observed to be complete.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. There are first aid supplies available.

LPA observed that the Licensee and assistant do have proof of immunization record and the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.

LPA issued a copy of the LIC 857 Children’s Records Review
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022
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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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GALLARDO FAMILY CHILD CARE
FACILITY NUMBER: 198020741
VISIT DATE: 03/21/2022
NARRATIVE
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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

LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

Licensee Gabriela Gallardo was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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/inspection-process.

Based on the LPA observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022
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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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GALLARDO FAMILY CHILD CARE
FACILITY NUMBER: 198020741
VISIT DATE: 03/21/2022
NARRATIVE
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Upon receipt of a report documenting a Type A deficiency or substantiated complaint, the licensee shall do the following:

1. Health and Safety Code Section 1596.8595 (c) - A licensed child care facility or home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of subdivision (a) of Section 1596.893b. Failure to comply with paragraph (1) shall result in an immediate civil penalty of one hundred dollars ($100).

2. Each licensed child day care facility shall post a copy of any licensing report pertaining to the facility that documents either a facility inspection or a complaint investigation that results in a citation for a violation that, if not corrected, will create a direct and immediate risk to the health, safety, or personal rights of children in care. Failure to comply with paragraph (1) shall result in an immediate civil penalty of one hundred dollars ($100).

3. Upon enrollment of a new child in a facility, the licensee shall provide to the parents or legal guardians of the newly enrolling child copies of any licensing report that the licensee has received during the prior 12-month period that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b.
4. The licensee shall require each recipient of the licensing report described to sign a statement (LIC 9224) indicating that he or she has received the document and the date it was received. The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. A copy of the parent Acknowledgement of Receipt of Licensing Reports Form was provided during this inspection.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Licensee, Gabriela Gallardo------ pg.5 of 5
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022
LIC809 (FAS) - (06/04)
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