426216589-7-12-2023-17-CC-FVEZ-CTNSJ6-20230712135436

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216589
Report Date: 07/12/2023
Date Signed: 07/12/2023 01:54:46 PM

Document Has Been Signed on 07/12/2023 01:54 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	GALLARDO FAMILY CHILD CARE		FACILITY NUMBER:	426216589
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	07/12/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Eugenia Gallardo		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 07/12/2023 at 11:20 AM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Pre-licensing Inspection of residence and met with Applicant, Eugenia Gallardo. LPA informed Applicant of the nature and purpose of the inspection. Applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 05:00 AM to 5:00 PM, Monday- Friday. The Applicant also informed LPA of the intention to provide care for children 0 months to 12 years of age. There are five (5) adults that lives in the home and five (5) adults have received criminal record clearance. LPA toured the interior and exterior of the residence with the Applicant. This is a single level home that consists of three (3) bedrooms, two (2) bathrooms, living room, kitchen, dining room, laundry room, outdoor yard and attached accessory dwelling unit (ADU). Applicant reported children will have access to the living room, dining area, one (1) bathroom and part of the outdoor yard. Meanwhile, three (3) bedrooms, one (1) bathroom, kitchen, laundry room, part of the outdoor yard and ADU will be inaccessible to children in care. LPA observed a gate making the kitchen inaccessible, door safety knobs on all the bedrooms and laundry room. In addition, LPA observed fences making part of the outdoor yard inaccessible as well as the attached ADU inaccessible. LPA observed the living room and dining room to have spacing and ventilation for children in care. LPA observed an fireplace in the living room that is covered and made inaccessible by a large couch. LPA observed the kitchen is made inaccessible by means of a gate. LPA observed sharps, medication and cleaning compounds are stored in a locked elevated cabinet in the kitchen. Additional cleaning compounds were also observed in the laundry room that is also inaccessible to children in care. The bathroom of the FCCH is observed to be clean and free of toxins. LPA observed all items, equipment, toys and furnishings are in good conditions and age appropriate. LPA observed a required fire extinguisher (2A10BC) in the home which was purchased on 06/03/2023. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

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: GALLARDO FAMILY CHILD CARE	FACILITY NUMBER: 426216589
	VISIT DATE: 07/12/2023

NARRATIVE

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The home has a combination smoke and carbon monoxide detector which were tested at 12:30 PM and found to be operable.

LPA and applicant toured the exterior of the residence. LPA notes the outdoor yard is complete fenced with exit door being secured. LPA notes the sides of the outdoor yard are made inaccessible by gate. The outdoor yard consists of cement. Applicant discussed adding additional canopies to add more shading to the children in care. Applicant will provide filtered water for children by means of individual water cups.

LPA's record review revealed Applicant completed Preventative Health training on 02/23/2023. Further, Applicant completed Mandated Reporter training on 03/19/2023 and Pediatric CPR/First Aid (EMSA approved) on 03/08/2023. Applicant completed FCCH orientation on 02/02/2023. LPA reminded Applicant of obligation to maintain current training and certifications. LPA reviewed Applicant's control of property document (rental agreement). LPA notes applicant is current with all required immunizations. Applicant does not have liability insurance for the home as of yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282).

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.

Applicant 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 Applicant 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 Applicant 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.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

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: GALLARDO FAMILY CHILD CARE	FACILITY NUMBER: 426216589
	VISIT DATE: 07/12/2023

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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.

Exit interview conducted and report was reviewed with the Applicant, Eugenia Gallardo. The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license will be noted as the present, 07/12/2023.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

LIC809 (FAS) - (06/04)

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