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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416759
Report Date: 02/23/2022
Date Signed: 02/23/2022 04:52:40 PM

Document Has Been Signed on 02/23/2022 04:52 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GUTIERREZ CASTRO, OMAR & SALAS, ANGELFACILITY NUMBER:
434416759
ADMINISTRATOR:GUTIERREZ CASTRO, OMARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 767-0195
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
02/23/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:28 AM
MET WITH:Angel Salas and Omar "Giovanni" Gutierrez CastroTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an announced Pre-licensing inspection. LPA met with Applicants Omar "Giovanni" Gutierrez Castro and Angel Salas and explained the reason for the inspection. The purpose of this inspection is Applicants are applying for a large Family Child Care Home (FCCH). However, due to not having one year of experience as a small FCCH provider or in a licensed child care center, Applicants are changing capacity to a small FCCH. Applicants understand that after a year of experience as a small FCCH that they can apply for a large FCCH. A updated LIC 279 was obtained during today's inspection. Present during today's inspection were Applicants, their sister-in-law, and their nephew. Applicants rent the home. A copy of the lease agreement was obtained during today's inspection.

There is board to post required postings, which includes but not limited to license, parent's rights, and facility sketch. There is working phone in the home. Applicant does not plan on obtaining daycare insurance at this time and understands that parents needs to fill the Affidavit Regarding Liability Insurance.

LPA toured the inside and outside of the home with Applicants. The off-limit areas inside of the home are the entire upstairs, closet downstairs, and pantry, and garage. The home was clean with heating and ventilation for safety and comfort. There are stairs, which are barricaded. Disinfectant, cleaning supplies, and other items that are dangerous to children were inaccessible to children. LPA reminded Applicants items that states to keep out of reach of children needs to be inaccessible. LPA observed that there is sufficient amount of toys for children. All toys and equipment were age appropriate. There are napping mats and a crib for children. LPA reminded Applicants that infants cannot share cribs.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2022
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GUTIERREZ CASTRO, OMAR & SALAS, ANGEL
FACILITY NUMBER: 434416759
VISIT DATE: 02/23/2022
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There were no baby walkers observed during today's inspection. There is a fully charged fire extinguisher, functioning smoke detector, and carbon monoxide detector. Applicants stated that there are no weapon, such as firearms, stored in the home. Applicant understands that smoking not permitted in the home.

The backyard will be used and is fenced. The off-limit area outside of the home is the west- side. There are toys and equipment for children. There were no bodies of water observed during today's inspection. LPA discussed with Applicants about plan for AC unit.

Applicants plan on transporting children and understands that children cannot be left alone and unattended in parked vehicles. Car Seat Law was discussed with Applicants.

The form of discipline that Applicants plan on using are redirection and talking. Applicants understands that children's personal rights cannot be violated, including no corporal punishments.
LPA also discussed with Applicants that any food brought from home needs to have the child's name and date on it.

LPA discussed the safe sleep regulations with Applicants 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 applicants 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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



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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC809 (FAS) - (06/04)
Page: 2 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GUTIERREZ CASTRO, OMAR & SALAS, ANGEL
FACILITY NUMBER: 434416759
VISIT DATE: 02/23/2022
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LPA reviewed with Applicants 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. COVID guidelines and posters were provided and discussed with Applicants.


The adults living in the home who are 18 and over are both Applicants, their brother-in-law, and sister-in-law. Applicants also have one minor nephew. Applicants stated that their brother-in-law, sister-in-law, and nephew will be moving out by 03/01/2022. All adults have cleared criminal record, child abuse index, or exemption, and TB clearance. Applicants were 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.

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.

Applicants have requested to be transferred to a Spanish speaking LPA.

Exit interview conducted and report was reviewed with the Applicants Omar "Giovanni" Gutierrez Castro and Angel Salas. Applicant Angel Salas translated to Applicant Omar during today's inspection. Applicants were advised that capacity will change to 8 and that a license for a Small Family Child Care Home will be granted and issued upon review and approval of Licensing Program Manager.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC809 (FAS) - (06/04)
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