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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700129
Report Date: 10/14/2022
Date Signed: 10/14/2022 02:05:35 PM

Document Has Been Signed on 10/14/2022 02:05 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:GIL, ANDREAFACILITY NUMBER:
015700129
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
10/14/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:licensee Andrea Gil TIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with licensee Andrea Gil for a CASE MANAGEMENT VISIT - INCREASE IN CAPACITY. All adults requiring background clearance have been cleared and associated to this facility. The home is one story home which consists of two bedrooms, two bathrooms, a kitchen, a garage, living room, dining room, and a large backyard. The Licensee lives in the house with her partner, daughter and son. Present for this inspection was licensee supervising three children (2 preschoolers and one infant). The hours of operation are 8:00AM- 5:30PM, Monday -Friday. The facility has Liability Insurance through Acord company. The facility has approved fire clearance.

The LPA inspected the facility for health and safety hazards.

Day care area: Living room, dining room, kitchen, hallway bathroom, and the backyard.
Off limit areas: All closets, Master bedroom, bedroom #2, garage, and the tool shed behind the garage.

The outdoor play area is age-appropriate and free of defects/dangerous conditions. There are ample age appropriate toys that appear to be safe, and in good condition. There are no pools, hot tubs, ponds, or any other bodies of water. All hazardous materials and toxins were observed to be made inaccessible to children. All bathroom/kitchen cabinets are latched to prevent children from access.The home has two fully charged 3A40BC fire extinguishers, working smoke detector, working carbon monoxide detector, working telephone, and fully stocked first aid kit. There are firearms stored at this facility in a locked firearm cabinet in an off-limits area inaccessible to children in care. The fireplace in the living room is not in use is covered by screening. The licensee CPR and first aid certificate is current and expires 4/10/2024. Licensee completed the Mandated Reporter Training which expires on 02/28/2024. Licensee has current immunization records on file.

see next page...

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2022
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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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: GIL, ANDREA
FACILITY NUMBER: 015700129
VISIT DATE: 10/14/2022
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 Staff-children ratios discussed with Licensee for a Large Family Child Care Home (FCCH). If there is no helper, Licensee will need to operate within the small FCCH in regard to ratios. If care is provided to the 7th and 8th child for a Small FCCH, or 13th and 14th child for a Large FCCH, the last two children need to be school aged (6 years old). A sample handout is given to Licensee today regarding Small/Large Family Child Care Home Capacity Limitations.

Applicant is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible.

During Inspection, 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.

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.



Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

Large Family day Care license is recommended effective 10/14/2022

Exit interview conducted and report was reviewed with the licensee Andrea Gil.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
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