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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518666
Report Date: 03/07/2025
Date Signed: 03/07/2025 04:17:35 PM

Document Has Been Signed on 03/07/2025 04:17 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:GAMBLE, LILIAFACILITY NUMBER:
410518666
ADMINISTRATOR/
DIRECTOR:		GAMBLE, LILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 952-8490
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 4DATE:
03/07/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Assistant-Samantha GambleTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On 3/7/2025, at approximately 1:30PM, Licensing Program Analyst (LPA) Alvarado conducted an unannounced Plan of Correction (POC) visit at the facility. LPA met with Licenses assistant, Samantha Gamble, and explained the purpose of the visit. Present during the visit was Licensee and assistant supervising a total of 4 (Preschool)children. At approximately 1:55 the licensee stepped out for an appointment.

During the Annual inspection visit on 1/7/2025, the Licensee received citation’s regarding Operation of A Family Child Care Home and Personnel Requirements. During today’s inspection conducted along with Licensee’s assistant Samantha Gamble, licensee assistant has only half of the CPR/First Aid completed. Licensee’s assistant was able to provide proof of the scheduled appointment to finish completing the other portion of CPR/First Aid scheduled for 3/8/2025.

As of today 3/7/2025 two out of the three citations will be cleared. Deficiencies cited on 3/7/2025, were cleared today. The Letter of Deficiency Citation Cleared were provided to the Licensee.

See LIC 809-D for deficiencies being cited today also on 3/7/2025 under the California Code of Regulations, Title 22, Division 12, Chapter 1. Regarding Personnel Requirements and License.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee assistant, Samantha Gamble

Appeal rights were provided to Licensee’s assistant, Samantha Gamble
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Diana Alvarado
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2025
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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Document Has Been Signed on 03/07/2025 04:17 PM - It Cannot Be Edited


Created By: Diana Alvarado On 03/07/2025 at 02:34 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GAMBLE, LILIA
FACILITY NUMBER: 410518666

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2025
Section Cited
CCR
102416(c)

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(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
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Licensee will submitt the completed CPR/First Aid Training to LPA Alvarado via email by 3/14/2025.
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Based on interview and record review, the licensee did not comply with the section cited above in one out of four persons, Licensee does not have a current CPR/First Aid completed. As LPA observed the licesnee leave the facility for an appointment which poses a potential health, safety or personal rights risk to persons in care.
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Type B
03/21/2025
Section Cited
CCR102369(b)(9)

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(b)(9)Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.

This requirement is not met as evidenced by:
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Licensee will submitt Proof of Current tuberculosis documentation to LPA Alvarado via email by 3/21/2025.
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Based on interview and record review, the licensee did not comply with the section cited above in one out of four persons, Licensee’s assistant does not have a current Tuberculosis (TB) test. As LPA Alvarado reviewed assistants Immunizations on file which poses a potential health, safety, or personal rights risk to persons in care.
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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:Ali Zebila
LICENSING EVALUATOR NAME:Diana Alvarado
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2025


LIC809 (FAS) - (06/04)
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