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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020741
Report Date: 04/14/2022
Date Signed: 04/14/2022 03:42:26 PM

Document Has Been Signed on 04/14/2022 03:42 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: 9CENSUS: 6DATE:
04/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Gabriela Gallardo. Licensee TIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Roxana Lopez and Lilli Babcock conducted an unannounced case management visit to provide the LIC 809 D which was unable to be printed on 4/4/2021 due to technical difficulties. LPAs met with Gabriela Gallardo, licensee who guided analysts on a tour of the facility. Assistant Silvana Gallardo was also present during the inspection.

During an Annual Required visit on 3/21/2022 Licensee was cited 2 type A’s for over-capacity and fingerprints and 1 type B for expired fire extinguisher.

On POC visit on 3/29/2022 Licensee was observed not following the limitations of her license with 7 children under the age of 5. LPA did clear deficiencies for fingerprints and fire extinguisher on this date.

On 4/4/22, during follow-up visit to the visit conducted on 3/29/2022, LPA cited a type A citation for not following limitations of license on 3/29/2022. However, due to technical difficulties LPA was unable to print the LIC 809d deficiency page.

Based on the LPA’s observations and records review on 3/29/2022 and 4/4/2022 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.



LPA’s cleared deficiency cited on 4/4/2022 and provided a copy of the Licensing Report to Gabriela Gallardo, licensee. LPA’s issued POC clearance letter during the visit.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2022
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 3
Document Has Been Signed on 04/14/2022 03:42 PM - It Cannot Be Edited


Created By: Roxana Lopez On 04/14/2022 at 02:52 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: 04/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/14/2022
Section Cited
HSC
1597.44(a)

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1597.44 (a) Small family day care homes; number of children: A small family day care home may provide care for more than six and up to eight children, without an additional adult attendant, if all of the following conditions are met: (a) At least one child is enrolled in and
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Per Licensee she has disenrolled two children under the age of 5 to be under compliance with the limitation of her license and will only have 6 children present a day. on 4/12/2022 Licensee, submitted a Lic 308 Declaration form with her written plan.
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attending kindergarten or elementary school and a second child is at least six years of age. This requirements was not met as evidence by: Based on LPA's observations and record's review Licensee had 7 children under the age of 5 present on 3/29/2022.
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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: 04/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022


LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 04/14/2022
NARRATIVE
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On today’s visit 4/14/2022 LPA observed 6 children present. Licensee is in compliance with the limitations of her license. LPA did observe the Notice of Site Visit Posted visible for parents and the 9224 Acknowledgement forms in the children's file.

LPA’s advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Licensee, Gabriela Gallardo

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
LIC809 (FAS) - (06/04)
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