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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624418
Report Date: 08/18/2022
Date Signed: 08/18/2022 09:34:17 AM

Document Has Been Signed on 08/18/2022 09:34 AM - 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:GORRICHATEGUI, BRUNAFACILITY NUMBER:
343624418
ADMINISTRATOR:GORRICHATEGUI, BRUNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 747-1921
CITY:SACRAMENTOSTATE: CAZIP CODE:
95827
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
08/18/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Bruna GorrichateguiTIME COMPLETED:
09:45 AM
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On Thursday, August 18, 2022 at 8:30 AM, Licensing Program Analysts (LPAs) Amanda Sutter and Office Technician (OT) Loveleen Arora met with Applicant Bruna Gorrichategui for the purpose of an announced change of location pre-licensing inspection. Applicant was previously licensed under facility #214005476. During today’s visit, the applicant’s two minor children were present in the home. All individuals subject to criminal background review have obtained a criminal record clearance. A Fire Safety Inspection Clearance was conducted 8/17/2022 but LPA has not yet received the clearance from the Sacramento County Fire Department. Applicant plans to operate Monday through Friday from 7:30 AM to 5:30 PM.

A health and safety inspection was conducted inside and outside the home. The facility is a one story home which includes 3 bedrooms, 2 bathrooms, kitchen, a living room, and a garage. Off-limit areas will include: garage, master bedroom, and master bathroom. Applicant understands that children may never enter these off-limit areas.

LPA observed cleaning supplies under kitchen sink. LPA observed sharp knives stored in as unlocked kitchen drawer. Children’s medications will be stored in the master bathroom, which is off-limits. A functioning smoke detector, carbon monoxide detector, and 2A10BC fire extinguisher were observed. Applicant stated that there are no weapons in the home. There are no bodies of water on the premises. LPAs discussed all required licensing postings and recommended COVID-19 posters.

Applicant Bruna Gorrichategui has completed the required Preventative Health and Safety course with the Lead Poisoning Prevention training. Current EMSA approved pediatric CPR/First Aid training was verified and expires 11/20/23. Applicant is exempt from Mandated Reporter training due to a language barrier but has taken the training. It expires 9/25/23.

PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2022
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: GORRICHATEGUI, BRUNA
FACILITY NUMBER: 343624418
VISIT DATE: 08/18/2022
NARRATIVE
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Applicant was encouraged to maintain supervision at all times. LPAs discussed requirements for staff, adult assistants, and adults living in the home. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed. Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within 7 days to remain in compliance. Applicant understands that children’s records are to be maintained according to Title 22 regulations and be accessible to licensing for up to three years.

LPAs explained to applicant that if she relocates and wants to continue to provide care, she must submit a change of location application and have the new home inspected. Applicant understands that if any structural changes are made to the home, licensing must be notified prior to construction. Applicant understands that if she want to make any off-limit area an on-limits area, licensing must be notified and LPA must do an inspection before children are allowed in the area. Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPAs reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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: http://www.ada.gov/childqanda.htm

PAGE 2. REPORT CONTINUES ON LIC809-C
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: GORRICHATEGUI, BRUNA
FACILITY NUMBER: 343624418
VISIT DATE: 08/18/2022
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LPAs discussed the safe sleep regulations with Applicant 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. LPAs also informed Director 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.

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 platform. 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.

Exit interview conducted and report was reviewed with the applicant Bruna Gorrichategui.

License is pending proof of:

- Proof of locked drawer storing knives in kitchen

- Proof of locked cabinet for cleaning supplies under sink

- Fire clearance

Once applicant submits proof of the above items, facility will be approved for a Large Family Child Care Home license for a capacity to serve up to either 14 children, two (2) of which must be at least 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
LIC809 (FAS) - (06/04)
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