<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421441
Report Date: 07/19/2021
Date Signed: 07/19/2021 05:03:05 PM

Document Has Been Signed on 07/19/2021 05:03 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:GALLEGOS, DEANNAFACILITY NUMBER:
013421441
ADMINISTRATOR:GALLEGOS, DEANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 294-9384
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
07/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:55 PM
MET WITH:Deanna GallegosTIME COMPLETED:
05:10 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 7/19/2021 at 3:55pm, Licensing Program Analyst (LPA) Jonathan Williams met with Deanna Gallegos for a Required 1 Year Inspection. Present for this inspection are the Licensee, one fingerprint cleared/associated assistant provider (Elen Ibadlit), the Licensee's fingerprint cleared and associated adult son, and four preschool-aged children in care. The facility was toured to conduct a health and safety inspection.

The home is a 2-story home and is tidy and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are family room, kitchen, dining room, living room, master bedroom, "grass area" in the backyard, and downstairs bathroom. The OFF LIMIT AREAS are the garage, entire second floor, and pool area, all of which will be made inaccessible to children by closed and/or locked doors, barricade, gate, and visual supervision. The ISOLATION ROOM is the dining room.

LPA toured the facility interior at 3:56pm. There are safe, operable, and age-appropriate toys and learning materials in the facility. All hazardous materials and toxins were observed to be made inaccessible to children during today's inspection. Per Licensee, there are no firearms kept in the home. There is a fireplace in the home which is screened to prevent access to children. LPA toured the backyard at 4:15pm. Backyard is fenced. There is a fenced pool in the backyard with a secure gate which opens outwards. All toys and play equipment in the backyard were observed to be safe, age-appropriate, and in operable condition.

The facility has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Licensee has current CPR/1st Aid training which expires on 7/20/2021. Mandated Reporter Training ("General" and "Child Care Providers") for Licensee expires on 5/20/2022. Mandated Reporter Training for assistant provider ("General" and "Child Care Providers") expires on 1/20/2022. The facility is in ratio today. Children's files and staff files were reviewed for proper documentation. Facility roster was obtained. Facility conducts fire/disaster drills at least once every six months.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GALLEGOS, DEANNA
FACILITY NUMBER: 013421441
VISIT DATE: 07/19/2021
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
26
27
28
29
30
31
32
Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS at this time. 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.”

Licensee was reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.
Licensee was reminded that California Law requires licensed Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the Licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

There are no deficiencies cited. This report shall remain on file for 3 years. A Notice of Site Visit was provided to the Licensee. LPA reminded the Licensee to post the Notice of Site Visit where it is clearly visible inside the facility for 30 days. Appeal rights were provided to the Licensee. Exit interview was conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2