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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408977
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:33:16 PM

Document Has Been Signed on 08/26/2021 01:33 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:GALVEZ, VERONICAFACILITY NUMBER:
073408977
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Veronica GarciaTIME COMPLETED:
01:35 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
Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced annual site inspection for this facility at 12:25 PM. LPA toured the facility for a health and safety inspection with licensee, Veronica Galvez, who was present with five preschool aged children in care. Children are being supervised and the facility is within ratio and capacity. All adults present are background cleared and associated to this facility.

The on limits areas for children will be the living room, dining area, bedrooms one and two, the hallway bathroom and the patio and backyard area. Off limits areas are made inaccessible by child safety gating or closed doors and visual supervision. Kitchen cabinets and drawers have safety latches. There are no hazardous items/toxins observed to be accessible to children today. The facility is clean and organized. There are age appropriate play equipment/toys that are free of sharp/broken pieces. The facility has a working carbon monoxide detector, working smoke detector and a fully charged 3A40BC fire extinguisher. Per licensee there are no firearms present or stored on the premises.

The back patio area and yard area is fully fenced and is on limits to children in care with adult supervision present at all times children are using the area. There is one piece of climbing equipment. There are no pools, hot tubs or other accessible bodies of water. There are no fireplaces or wall heaters present. There is available infant sleeping equipment (crib) which is in safe condition.

Continued on Page 2*********************************************************************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Paul Peterson
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2021
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: GALVEZ, VERONICA
FACILITY NUMBER: 073408977
VISIT DATE: 08/26/2021
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
Page 2**************************************

LPA reviewed with licensee the current facility background clearances list and verified that all adults requiring background clearances are cleared and associated to this facility. Children's files were reviewed for parent's rights forms and identification and emergency information forms. Facility records were reviewed for licensee's immunization records and mandatory reporter training certificate. The facility roster is current. Licensee's CPR/First Aid will expire in 08/23. All required postings are present.

Safe Sleep regulation guidelines were reviewed and a copy of safe sleep guidelines provided along with a copy of the LIC9227. Licensee is encouraged to frequently visit www.ccld.ca.gov for licensing regulations and forms. Visit
https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe to subscribe to email notification of Community Care Licensing PINs. For Quaterly updates visit https://www.cdss.ca.gov/inforesources/community-care/self-assessment-guides-and-key-indicator-tools/quarterly-updates.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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

There were no deficiencies cited today. An exit interview was conducted with licensee and a notice of site visit was provided and is to be posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Paul Peterson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2