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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216479
Report Date: 11/08/2022
Date Signed: 11/08/2022 10:58:53 AM

Document Has Been Signed on 11/08/2022 10:58 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GALLEGOS FAMILY CHILD CAREFACILITY NUMBER:
406216479
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/08/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Liliana GallegosTIME COMPLETED:
11:15 AM
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Previous Facility Number 406216207
On 11/8/22, at 9:00 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an announced Prelicense/ Change of Location Inspection of the abovementioned Family Child Care Home (FCCH). As noted above the previous facility number is 406216207. LPA met with Liliana Gallegos, Licensee of the FCCH and explained the purpose of the inspection. LPA, in the company of the Licensee, toured the interior and exterior of the FCCH. The FCCH is a three bedroom, two bathroom unit on the first floor of an apartment complex. The home’s living room, kitchen, hallway bathroom and outdoor patio will be utilized for child care services, while the home’s bedrooms are excluded from child care. LPA observed child safety gates at the hallway leading to the bedroom and at the entry to the outdoor patio. LPA notes no children are present during the inspection.

The FCCH is orderly and bathroom used by children in care is clean and free of toxins. LPA observed cleaning compounds stored in a locked cabinet underneath the sink, while medication in the FCCH is stored in an elevated kitchen cabinet which is inaccessible to children. Sharps are in a plastic container atop of the refrigerator which is beyond the reach of children. Toys, furniture and equipment in the FCCH is age appropriate.

Required forms and documents are posted on the wall near the entry door of the FCCH. LPA observed a smoke and a carbon monoxide detector in the FCCH. Each detector was tested at 10; 00 AM and found to be operable. LPA observed a regulation fire extinguisher (2A10BC) in the FCCH which was purchased on 11/6/22. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA notes no fireplace is in the FCCH.

Licensee will use the outdoor patio and the community play area in the middle of the housing complex for outdoor activities. The patio is completely enclosed and toys/play equipment in the area are age appropriate. The community play area contains a number of play structures and outdoor furnishings. The area is not
(CONT. LIC 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 406216479
VISIT DATE: 11/08/2022
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enclosed. LPA observed no bodies of water on site. LPA remind the LIcensee to ensure children in care are afforded direct supervision when children are engaged in activities in the community play area. Further, LIcensee is reminded to ensure children are accessing age appropriate play structures when engaged in activities in the community play area.

LPA's record review revealed Licensee completed Preventative Health training on 9/23/21. Further, Licensee completed Mandated Reporter training on10/6/21 (expiration 10/6/23) and Pediatric CPR/First Aid (EMSA approved) on 7/17/21 (expiration 7/17/23) . LPA reminded Licensee of obligation to maintain current training and certifications. LPA reviewed Licensee's control of property document (Lease Agreement). Licensee does have liability insurance for the home as of yet. LPA provided Licensee with Affidavit Regarding Liability Insurance form (LIC 282). Licensee informed LPA no firearms or ammunition are on site.

LPA reviewed with Licensee 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.

Licensee 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.

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.

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

(CONT. LIC 809-C Page 3)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GALLEGOS FAMILY CHILD CARE
FACILITY NUMBER: 406216479
VISIT DATE: 11/08/2022
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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 Licensee Liliana Gallegos. The home meets Title 22 Division 12 requirements of a small FCCH license. The change of location is granted and the effective date of license will be noted as the present, 11/8/22.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC809 (FAS) - (06/04)
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