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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364819926
Report Date: 03/07/2024
Date Signed: 03/07/2024 04:46:35 PM

Document Has Been Signed on 03/07/2024 04:46 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:GORE FAMILY CHILD CAREFACILITY NUMBER:
364819926
ADMINISTRATOR:GORE, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 272-1512
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/07/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:38 PM
MET WITH:GORE LINDATIME COMPLETED:
04:59 PM
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Licensing Program Analyst (LPA) Babatunde Ibitoye met with Licensee, Gore Linda, who guided the analyst on a facility tour for a Required Annual inspection. This is a single story 4- bedroom, 2- bathroom home with kitchen, dining, laundry room, backyard and garage. There is no pool/or body of water on the premises. Family members residing in the home include three adults (Licensee, licensee Husband, adult daughter) and two grand children. Days/hours of operation Monday through Friday 7 am to 5:30pm hours. Incidental Medical Services (IMS) policy was discussed. Upon arrival,there are no children in care. There are currently (4) children enrolled in the family childcare

Licensee's Husband was present during this inspection, all adults have fingerprint clearances and associated to the home. exams for T.B., and required immunization's. Licensee is associated to the Early Child Care Education unit with Child Care Resource Center.The family room; backyard; 1 bedroom; and the front bathroom are designated for child care. Off-limit areas are identified as 3 bedrooms, 1 bathroom, kitchen, and the garage, off limits areas are inaccessible to children.



Physical Plant: The home is clean and orderly, the fireplace is screened, age-appropriate toys and play equipment, a working smoke detector and carbon monoxide detector, and a 2A10BC Fire Extinguisher, no one smokes in the home.There is a designated area for the ill child(ren) as necessary, no weapon/firearms, facility sketch complete and current,

There is a working telephone (cell), poisons, and cleaning items inaccessible (in the laundry room, kitchen lower cabinets with a latch) to children. The home has central AC and heat.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (laundry room), medicines (off-limits bedroom), and hazardous items (sharp knives in kitchen cabinet with safety latch) that can pose a danger to children. Fire/earthquake drills were completed and maintained current (03/04/2024). Roster complete and maintained current.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GORE FAMILY CHILD CARE
FACILITY NUMBER: 364819926
VISIT DATE: 03/07/2024
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Safe and age-appropriate toys, play equipment, and materials. Electrical outlets are inaccessible, and no baby bouncer’s saucer chairs or any recalled or prohibited toys or sleep/play equipment were observed on the premises. There are age-appropriate napping (cots, mat) equipment.

Pets: Per the licensee, there are 1 dog and 1 cat in the home .per licensee all the shot record a current.

Bathroom: Shower/tub free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, and nail polish. The toilet and faucet are clean and operable.

Kitchen: Sharp items (knives in kitchen cabinet with safety latch) are inaccessible and the home has a clean fully stocked food refrigerator/freezer. No chemicals in the kitchen were observed to be accessible. Licensee serves Breakfast, lunch, dinner, and snacks.

Outdoor: The yard was toured and found to be safe for children (inaccessible – lawn mower, gardening tools, poisonous plants, thorn trees, cactus, pets). Licensee must always provide Supervision while children our participating in outside play. LPA observed a shaded covered patio area as you exit onto the backyard, 1 large play apparatus with swing attached and another jungle gym along with other play equipment. This play area is clear and clean of debris. There are age appropriate toys on the patio.

Advisory/Other: First Aid kit was observed with supplies readily available. The licensee has CPR/First Aid 12/04/2024 and the Mandated Reporter expires 08/15/23 See Lic 809D. Electrical outlets are inaccessible. There are no window cords accessible to children. Children nap in Bedroom #1 and sleep on cots.

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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GORE FAMILY CHILD CARE
FACILITY NUMBER: 364819926
VISIT DATE: 03/07/2024
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The following was discussed with the Licensee:

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter (www.mandatedreporterca.com) were reviewed, to be completed every two years; Licensee reminded that 100% supervision is required at all times to children in care; Licensee made aware that it is his/her/their responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the daycare. Per the Licensee no one smokes in the home. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. Licensee advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov.

The license advised of the requirement to report Unusual Incidents. The licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of the family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.

The licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to part obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from the parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family childcare home or grounds, the Licensee shall notify the Department of the proposed change, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "childcare" room; Room additions to the family child care home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition, or construction.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GORE FAMILY CHILD CARE
FACILITY NUMBER: 364819926
VISIT DATE: 03/07/2024
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The licensee 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, before 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.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family childcare home and to privately interview children or staff, to determine compliance with or to prevent violations of family childcare laws or regulations, also enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

LPA discussed the safe sleep regulations with the licensee and also instructed the Licensee to visit 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. 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.

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 platforms.

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.

Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Deficiency see 809D.The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8 am-5 pm. An exit interview was conducted, and the report was reviewed with the Licensee Gore Linda

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/07/2024 04:46 PM - It Cannot Be Edited


Created By: Babatunde Ibitoye On 03/07/2024 at 04:14 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GORE FAMILY CHILD CARE
FACILITY NUMBER: 364819926

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/11/2024
Plan of Correction
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Licensee will email proof of completion by 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:Claretta Yates
LICENSING EVALUATOR NAME:Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024


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