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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421441
Report Date: 03/14/2022
Date Signed: 03/14/2022 12:38:09 PM

Document Has Been Signed on 03/14/2022 12:38 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: 14CENSUS: 13DATE:
03/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Deanna GallegosTIME COMPLETED:
12:55 PM
NARRATIVE
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On 3/14/2022, Licensing Program Analyst (LPA) Jonathan Williams arrived at the facility unannounced for the purposes of conducting a Required 1-Year Inspection. LPA was met by Licensee, Deanna Gallegos. Present for today's inspection are the Licensee, two fingerprint cleared and associated assistant providers, and 13 children in care (five infants and eight preschoolers). No other individuals were present in the home during today's inspection. Facility operating hours are 7am-5:30pm M-F. The facility was toured to conduct a health and safety inspection.

The home is a 2-story home consisting of the following on and off-limit areas. 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 are inaccessible to children at this time by closed and/or locked doors, barricade, gate, and visual supervision. The ISOLATION ROOM is the dining room.

At 9:10am, LPA toured the facility interior. The home is tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the home. Fireplace is screened. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. Food/beverages capable of rapid spoiling are properly stored. Uncontaminated drinking water is available to children. There is a small dog kept in the home. There are chickens kept in the pool area inaccessible to children. There are no firearms kept in the home at this time, per Licensee. Nobody smokes in the home, per Licensee.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2022
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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Document Has Been Signed on 03/14/2022 12:38 PM - It Cannot Be Edited


Created By: Jonathan Williams On 03/14/2022 at 11:41 AM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GALLEGOS, DEANNA
FACILITY NUMBER: 013421441

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)(2)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above. LPA observed that five infants and eight preschoolers were present in the home at the same time, placing facility out of ratio. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/24/2022
Plan of Correction
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Licensee shall bring facility into ratio per the regulations concerning staff-child ratios by the POC due date. LPA discussed ratio requirements for a large Family Child Care Home with Licensee. POC shall be verified by LPA inspection.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Wynn Norona
LICENSING EVALUATOR NAME:Jonathan Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/14/2022 12:38 PM - It Cannot Be Edited


Created By: Jonathan Williams On 03/14/2022 at 11:41 AM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GALLEGOS, DEANNA
FACILITY NUMBER: 013421441

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review conducted by LPA, the licensee did not comply with the section cited above. LPA osberved that documentation verifying immunization against pertussis were missing for staff member S3. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/24/2022
Plan of Correction
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Licensee shall obtain immunization documents for pertussis for S3 and submit documents to LPA via mail, email, or fax by the POC due date.
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above. Front yard of the facilitty was placed "on-limits" for use by children without notifying the Department so inspection could be conducted. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/24/2022
Plan of Correction
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Licensee shall submit written statement explaining knowledge of reporting requirements regarding changing an "off-limit" area to an "on-limit" area.
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:Wynn Norona
LICENSING EVALUATOR NAME:Jonathan Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022


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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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GALLEGOS, DEANNA
FACILITY NUMBER: 013421441
VISIT DATE: 03/14/2022
NARRATIVE
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At 9:24am, LPA toured the backyard. All play equipment was observed to be operable and age-appropriate during this inspection. The backyard is fenced. There is a fenced pool in the backyard with a secure gate which opens outwards.

At 10:41am, LPA toured the front yard, previously absent from identified "on-limits" areas. Front yard contains a grassy area and is fenced. There are no high climbing structures, pools, hot tubs, or bodies of water in the front yard. All play equipment was observed to be operable and age appropriate at this time. Front yard is now to be considered an "on-limits" area of the facility.

The facility has a fully charged 2A10BC fire extinguisher and working telephone. Carbon monoxide detector and smoke detector are functional. CPR/1st Aid and Mandated Reporter certificates for Licensee are current. Children's files were reviewed for proper documentation. Roster was obtained.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care 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 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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022
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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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GALLEGOS, DEANNA
FACILITY NUMBER: 013421441
VISIT DATE: 03/14/2022
NARRATIVE
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Licensee was reminded that California Law requires licensed Family Child Care Homes 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 624b). 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.

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.

Deficiencies were cited today, including one Type A deficiency. LIC9224 must be delivered to and signed by all parents of children in care and parents of all children subsequently enrolled for a period of 12 months from today's date. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided to the Licensee and the signature on this form acknowledges receipt of these rights. Exit interview was conducted and report was reviewed with the Licensee.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022
LIC809 (FAS) - (06/04)
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