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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004611
Report Date: 10/06/2022
Date Signed: 10/06/2022 12:59:55 PM

Document Has Been Signed on 10/06/2022 12:59 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:GATE,GELMAFACILITY NUMBER:
384004611
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
10/06/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gelma GateTIME COMPLETED:
11:00 AM
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On October 6, 2022 at approximately 9:30am, Licensing Program Analyst (LPA) Winnie Ly conducted a Case Management Visit-Licensee Initiated for an increase of capacity from a small family child care to large family child care. LPA met with licensee Gelma Gate. Purpose of visit was explained. Present during the visit was licensee caring for 5 children. Licensee rent this two bedroom house and resides here with her pet. Per Licensee, she did not obtain Landlord Consent and will operate child care without enrolling school age children.

During today's visit, LPA and licensee toured the day care areas. Day Care Areas are the kitchen, one bedroom, bathroom and the backyard. Off Limit Areas are Licensee's bedroom, Living room and the garage. LPA observed the home is clean orderly and properly ventilated. Telephone service, heating, lighting and ventilation were evaluated. LPA observed a 2A10BC Fire extinguisher, operable smoke detector and carbon monoxide are available throughout the home. LPA observed no bodies of water in the home. LPA observed a fireplace in the living room of the home. Fire place is not in use and inaccessible to children. Electrical outlets have child protective covers in place making them inaccessible to children. Chemical, detergents, cleaning compounds, medications, and other items of this nature are made inaccessible to children. Kitchen/Bathroom cabinets/drawers have child protective covers in place. Per Licensee, home does not have firearms or dangerous weapons.

Licensee’s CPR/First Aid expires 05/2024. Completed Child Abuse Mandated Reporter Training certificate is on file. Required Immunization Influenzas, Pertussis and Measles are on file. Fire Clearance has been granted by San Francisco Fire Department on 09/21/2022.

Large Family Child Care License is approved and will be effective as of today, 10/06/2022.

A copy of this report and appeal rights were discussed and left with Licensee whose signature on this form confirm receipt of reports. Notice of Site Visit was provided to licensee. Licensee was advised Notice of Site Visit to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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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