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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618209
Report Date: 10/23/2023
Date Signed: 10/23/2023 08:49:33 PM

Document Has Been Signed on 10/23/2023 08:49 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AVILA, GLIDAFACILITY NUMBER:
343618209
ADMINISTRATOR:AVILA, GLIDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 420-5871
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
10/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Glida AvilaTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst Erwina Pascual-Golamco (LPA) conducted an unannounced annual inspection and met with Licensee, Gilda Avila. LPA observed 10 children in care with licensee and cleared assistant. Facility hours of operation are Monday through Friday 6:30 AM – 5:30 PM. LPA observed that the annual facility fees are current.

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 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.

Off-limit areas include: UPSTAIRS, DOWNSTAIRS BEDROOM, LAUNDRY ROOM, GARAGE. Licensee acknowledged that children may never enter these off-limit areas. The fireplace and stairs are fenced or barricaded. LPA conducted a health and safety inspection and observed that the facility is clean, orderly, with heating and ventilation for safety and comfort. LPA observed the required documents were posted where visible to parents. LPA observed hazardous items—such as cleaning compounds and medications, accessible to children. Licensee removed the hazardous items and placed it in the laundry room cabinet that is not accessible to children. The 2A-10-BC fire extinguisher appeared to be in working condition and accessible. The facility has equipment and age-appropriate materials for children. Licensee stated there are no weapons or firearms on the premises. The backyard is fenced, and licensee acknowledged that in areas that are not fenced, 100% supervision is required. LPA did not observe bodies of water on the premises.

continued on LIC809C...
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2023
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: AVILA, GLIDA
FACILITY NUMBER: 343618209
VISIT DATE: 10/23/2023
NARRATIVE
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LPA observed a current children's roster and fire drill log which was last conducted on 9/18/23. LPA reviewed children’s files and provided technical assistance regarding required documentation in children's files. LPA observed the CPR/First Aid certificate was valid until 12/24 for Licensee and assistant. Mandated Reporter Training (MRT) certificate was valid until 02/25 for assistant and technical assistance provided for licensee regarding current mandated reporter certificate. Licensee was reminded both CPR/First Aid and MRT Child Care portion must be completed every two years. LPA reviewed staff and facility files and provided technical assistance regarding required documentation.

LPA discussed the safe sleep regulations with licensee and the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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

continued on LIC809C...
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
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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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: AVILA, GLIDA
FACILITY NUMBER: 343618209
VISIT DATE: 10/23/2023
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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 inspection, interview, and record review, Type A Title 22 Deficiencies have been issued on the attached LIC 809-D page. The Licensee shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report.

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. A signed Acknowledgement of Receipt of the Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 10/20/23. A notice of site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview was conducted, and Licensee has been provided with appeal rights. Report was reviewed with the licensee, Glida Avila.









SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6
Document Has Been Signed on 10/23/2023 08:49 PM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 10/23/2023 at 03:06 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: AVILA, GLIDA
FACILITY NUMBER: 343618209

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above as LPA observed detergents, cleaning compounds, and medication in areas accessible to children which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/23/2023
Plan of Correction
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Licensee removed items and placed in top cabinet in the laundry room and cabinet in top shelf in kitchen. Deficiency cleared at time of LPA visit.
Type A
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as LPA observed 1 infant (over 12 months old) asleep in a closed room that is in off limits area which poses an immediate health, safety or personal rights risk to persons in care.

in [count] out of [total count] [(objects) (persons)] [identifiers]
POC Due Date: 10/23/2023
Plan of Correction
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LPA provided technical assistance and licensee moved infant to an area accessible to children. Deficiency cleared at time of LPA visit.
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:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2023


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 10/23/2023 08:49 PM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 10/23/2023 at 03:06 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: AVILA, GLIDA
FACILITY NUMBER: 343618209

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as LPA did not observe assistant's pertussis immunization record on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/06/2023
Plan of Correction
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Licensee stated she will get record from employee and place it in staff file. Licensee will email LPA documentation by 4PM on POC due date.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as LPA did not observe assistant's pertussis immunization record on file, and Licensee stated she did not get dodumentation from assistant when hired in 01/23, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/06/2023
Plan of Correction
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Licensee stated she will get ask employee to get an appointment to get immunization employee and place documentation in staff file. Licensee will email LPA documentation by 4PM on POC due date.
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:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2023


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 10/23/2023 08:49 PM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 10/23/2023 at 03:06 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: AVILA, GLIDA
FACILITY NUMBER: 343618209

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as LPA did not observe sleep logs for 2 out of 3 infants under two years old. Licensee showed a laminated sheet for the other infant's sleep log, but does not have record in child's file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/06/2023
Plan of Correction
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Licensee stated she will document and file sleep logs for infants under 2 years old moving forward. Licensee will email LPA attestation that she is documenting sleep logs for infants under 2 years old moving forward by by 4PM on 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:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2023


LIC809 (FAS) - (06/04)
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