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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101205
Report Date: 07/15/2022
Date Signed: 07/15/2022 11:22:35 AM

Document Has Been Signed on 07/15/2022 11:22 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CAZARES, GINA FAMILY CHILD CAREFACILITY NUMBER:
376101205
ADMINISTRATOR:GINA CAZARESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 315-1373
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
07/15/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA), Tyra Block, conducted an announced Pre-Licensing Change of Location inspection with the applicant. The single story, 5 bdrm, 3 ba home was toured and inspected to ensure an environment safe for the care and supervision of children. Licensee rents the home and has provided proof of control of property. The fire extinguisher (3A40BC), carbon monoxide detector and smoke detector meet requirements and are operational. All poisons, cleaners, and hazardous items were latched/locked and secured out of reach of children, and electrical outlets were covered. There are no bodies of water in the home. Licensee states that there are no weapons in the home. Licensee has certified on the application she has sufficient financial resources to sustain the license. A review of staff records on this date indicates that all facility staff/ residents or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. First Aid and CPR expire on 1/2024. Mandated Reporter Training was completed on 8/2021. Licensee and adult residents have TB clearance and immunization requirements were met. Fire Clearance granted 7/12/22.

Licensee will be using the following rooms for childcare: Living Room, Kitchen, Play Room, and bedroom #2. The following areas will be off limits: Garage and Bedrooms #1,3, 4, and 5. They are made inaccessible with the use of lock and child safety gate. The Licensee has sufficient toys and equipment available for children. The home has a fenced backyard available for outdoor activities. Licensee understands visual supervision is to be maintained at all times when away from the facility. Advised no changes should be made to the home without prior notice and/or approval from Licensing.

LPA 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. Reminded licensee about child abuse reporting, roster, emergency drills, ratio/capacity, immunizations, the YMCA Resource Center and that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats are not allowed in day care. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2022
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: CAZARES, GINA FAMILY CHILD CARE
FACILITY NUMBER: 376101205
VISIT DATE: 07/15/2022
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LPA discussed the safe sleep regulations with licensee 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. 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.

LPA discussed 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, 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. Any minor upon his/her 18th birthday must be fingerprinted within 30 days.



This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

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. Applicant was encouraged to subscribe.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
LIC809 (FAS) - (06/04)
Page: 3 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: CAZARES, GINA FAMILY CHILD CARE
FACILITY NUMBER: 376101205
VISIT DATE: 07/15/2022
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Applicant is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for forms and updated regulation information. Duty Line was provided: (619) 767-2248. Southern California Child Care Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

No corrections are needed. A license for 14 children will be issued


LPA discussed the following with Licensee: MAX. CAP (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN
KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

When caring for more than 12 children, Landlord Consent must be on file in licensing folder and Parent Notification of Additional Children in Care must be maintained in each child's file.

Exit interview conducted and report was reviewed with the Licensee, Gina Cazares.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
LIC809 (FAS) - (06/04)
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