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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100949
Report Date: 12/03/2021
Date Signed: 12/03/2021 09:41:23 PM

Document Has Been Signed on 12/03/2021 09:41 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GARIBAY, ELIZABETH FAMILY CHILD CAREFACILITY NUMBER:
376100949
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/03/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Elizabeth GaribayTIME COMPLETED:
11:00 AM
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On 12/3/21 at 8:35 AM, Licensing Program Analyst (LPA) Keturah Lane, conducted an announced Pre-Licensing inspection for relocation with the applicant. Upon arrival, LPA met with applicant Elizabeth Garibay and also present were applicant’s husband, niece and her niece’s minor daughter. The two-story home is divided into two apartments – a lower and upper unit. There is another family living in the upper unit. Since the units have the same physical address, LPA Lane explained that the occupants of the upper unit need to be fingerprint cleared (TB results & LIC508 as well) or contact the city to apply for a separate mailing address before license can be approved. The home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water in the home. Applicant states that there are no weapons in the home. CPR and First Aid expire on 6/20/22. Preventative health practices course was completed on 12/8/19. Lead poison prevention training was completed on 8/14/20. Mandated reporter training was completed and expires on 8/3/22. Staff immunizations requirements were met. Required documents have been posted. Applicant rents the home. The applicant has toys and equipment available. Applicant will be using the following rooms for childcare: daycare room, ktichen, living room and bathroom. Off-limit areas include: Room #1, Room #2, office and laundry room and are inaccessible through the use of door-knob covers. The upper unit is only accessible through an outdoor entrance. The home has a fenced backyard available for outdoor activities. Applicant was reminded of requirements for children’s records, child abuse, and unusual incident reporting, immunizations, adults living or working in the home and associated civil penalties, applicant was also reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA provided information regarding Safe Sleep Regulations/SIDS and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law: www.meganslaw.ca.gov. LPA Lane reviewed Covid-19 guidelines with applicant and provided Covid-19 resources. LPA Lane directed applicant to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2021
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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GARIBAY, ELIZABETH FAMILY CHILD CARE
FACILITY NUMBER: 376100949
VISIT DATE: 12/03/2021
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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.

The following corrections are needed prior to the issuance of the license:
1. Have occupants of upper unit obtain fingerprint clearance & submit TB test results & LIC508 criminal record statements
OR
2. Obtain separate physical address from City of El Cajon and provide proof of address update to LPA Lane
Once all corrections are made and proof is sent to licensing a license for 8 children may be granted. Applicant understands that proof of corrections must be submitted to Licensing within 30 days or the application may be denied. Applicant agreed to comply with all regulations and laws governing family child-care homes.

An exit interview was conducted with applicant. Applicant was provided a copy of their Appeal Rights (LIC9058) along with a copy of the report (LIC809) and their signature on this form acknowledges receipt of these rights.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC809 (FAS) - (06/04)
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