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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376622788
Report Date: 08/08/2023
Date Signed: 08/08/2023 02:59:06 PM


Document Has Been Signed on 08/08/2023 02:59 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:GAITAN, TERESA FAMILY CHILD CAREFACILITY NUMBER:
376622788
ADMINISTRATOR:TERESA GAITANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 560-1276
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:14CENSUS: 11DATE:
08/08/2023
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Theresa GaitanTIME COMPLETED:
03:15 PM
NARRATIVE
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On 8/8/23 at 12:00 PM, Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced Annual inspection with the Licensee. Upon arrival, LPA met with Licensee, Theresa Gaitan. Also present in the home were Licensee's husband Enrique Gaitan, two assistants Martha Aspuro and Maria Lourdes Escamilla and 11 daycare children including two infants. Proper supervision and ratios were observed. The two-story four bedroom three bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, 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. The Licensee owns the home and has provided proof of control of property.

Licensee’s First Aid and CPR certifications expire on 2/2025 and mandated reporter training certificate expired 2/22/23. Assistant Martha Aspura’s First Aid and CPR certifications expire on1/2024 and Mandated reporter training on 1/13/24. Assistant Maria Lourdes Escamilla’s First Aid and CPR certifications expire 2/2025 and mandated reporter on 7/26/25. Licensee and staff Martha meet immunization requirements. Licensee was unable to find immunization record and tb test result for assistant Maria Lourdes Escamilla. Licensee maintains emergency records for children. LPA reviewed a sample of Children’s Records. All child files were complete. Last Fire and Earthquake drills were conducted 4/14/23. All required postings were present. Licensee maintains a current facility roster of the children which LPA obtained during time of inspection.



(continued on LIC809 page 2)
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GAITAN, TERESA FAMILY CHILD CARE
FACILITY NUMBER: 376622788
VISIT DATE: 08/08/2023
NARRATIVE
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(LIC809 page 2)

Licensee has provided adequate space for the children to eat, sleep and play within the home. The following areas are used for day-care: living room, dining room, family room, downstairs bathroom & backyard. Off limits areas are entire upstairs and attached garage and are made inaccessible to day care children using doorknob covers, latches, locks, and safety gates. No bodies of water were observed during time of inspection. There is a working fire extinguisher rated 2A10BC, smoke and carbon monoxide detectors are present and operational. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children using cabinet latches and/or placed in off limit areas. Adequate heating and ventilation is provided for day-care children. Licensee states there are no firearms or weapons in the home. Licensee was advised to ensure that hazardous items are made inaccessible inside and outside the home. Licensee was also reminded to follow all safe sleep regulations including keeping safe sleep logs for all children under 2 and ensuring that all children under 12 months have safe sleep plans completed and placed in the child files. LPA provided Licensee safe sleep guidelines.

The fireplace is screened and the staircase is barricaded. There is a working phone at the facility. The licensee has sufficient age appropriate, safe, toys and equipment available. The home has a fully fenced backyard available for outdoor activities.

Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances associated to the facility, corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA Mangina reviewed Covid-19 guidelines with Licensee and provided Covid-19 resources. LPA Mangina directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information.

(continued on LIC809 page 3)

SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023
LIC809 (FAS) - (06/04)
Page: 2 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GAITAN, TERESA FAMILY CHILD CARE
FACILITY NUMBER: 376622788
VISIT DATE: 08/08/2023
NARRATIVE
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LIC809 page 3)
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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (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.



On this date, 8/8/23 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.
(continued on LIC809 page 4)
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023
LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 08/08/2023 02:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: GAITAN, TERESA FAMILY CHILD CARE
FACILITY NUMBER: 376622788

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as Licensee does not have current mandated reporter training certificate available which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/29/2023
Plan of Correction
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Licensee states will provide current mandated reporter training certificate to LPA no later than close of business 8/29/23.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as staff 2 file does not have TB or immunization records which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/29/2023
Plan of Correction
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Licensee States will provide LPA with staff 2 TB and immunization record no later that close of business 8/29/23.
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: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2023
LIC809 (FAS) - (06/04)
Page: 4 of 8


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GAITAN, TERESA FAMILY CHILD CARE
FACILITY NUMBER: 376622788
VISIT DATE: 08/08/2023
NARRATIVE
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(LIC809 page 4)

See LIC 809-D for deficiencies cited.

Exit interview conducted and report was reviewed with the Licensee, Theresa Gaitan. A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023
LIC809 (FAS) - (06/04)
Page: 8 of 8