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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409330
Report Date: 12/22/2022
Date Signed: 12/22/2022 01:31:20 PM

Document Has Been Signed on 12/22/2022 01:31 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:GATTI, CRYSTALFACILITY NUMBER:
073409330
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/22/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Crystal GattiTIME COMPLETED:
01:45 PM
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On 12/22/2022 at 09:50 AM, Licensing Program Analyst (LPA) Christina Watts conducted an announced Pre-licensing Inspection at Crystal Gatti's home and met with Applicant, who has applied for a Small Family Child Care Home with a capacity of eight (8). Living in the home are applicant, applicant two adult roommates and applicant two minor children ages 4 and 3 years old. Present during inspection was applicant and applicant's 2 minor children. Days and hours of operation will be Monday – Friday from 6:00 AM - 6:00 PM.

Applicant completed 8 hour Preventative Health & Safety training, Nutrition and Lead Poisoning training, 8 hour Pediatric CPR & First Aid Certificate that expires 06/2024, has documentation for Pertussis and Influenza opt out statement for the current flu season. Applicant did not provide documentation for Measles. Applicant will submit Measles vaccine documentation. Applicant and adults living in the home have Criminal Record and Child Abuse Index Clearance and documentation for Tuberculosis (TB) clearance. Applicant's adult roommates has not submitted Tuberculosis clearance. Applicant stated she will provide documentation from roommate. Applicant has completed and submitted certificate for Mandated Reporter training which expires 05/2024. Applicant rents the home. Applicant has provided rental agreement. LPA reminded that when care for more than six and up to eight is provided, Applicant must notify parents. Applicant will use the Affidavit Regarding Liability Insurance form to inform parents they do not carry a day care insurance. Applicant has a working telephone in the home.

Three story Home comprises of 4 bedrooms, 2 1/2 bathrooms, Family Room, Living Room, Laundry Room, Kitchen, Dining room, Attached Garage, and Backyard
Areas on limits: Living Room, Half bathroom, and Family Room
Off-Limit Areas: 4 bedrooms including master bedroom, 2 bathrooms, Laundry Room, attached garage and backyard.
Isolation Area: Family Room

*CON'T ON PAGE 2*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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 4
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: GATTI, CRYSTAL
FACILITY NUMBER: 073409330
VISIT DATE: 12/22/2022
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*PAGE 2*

LPA toured the indoor space of the home. The home is sanitary and orderly, with heating and ventilation for safety and comfort. There are stairs in the home. Stairs to the living room are made inaccessible to children. Stairs to the third floor is required to be made inaccessible to day care children. Applicant stated she will install baby gate to make third level inaccessible to children. Fireplace is located in the Living Room and made inaccessible. LPA observed fully charged 2A10BC fire extinguisher, working smoke, carbon monoxide detector. Medicines, cleaning products, sharp objects are stored inaccessible to children. Door access to off limit areas are made inaccessible to children. LPA reminded applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. Applicant states there are no firearms and ammunition stored in the home. LPA observed 2 dogs in the home.


Outdoor Space: LPA toured the outdoor area. Backyard has 3 levels and a deck that leads to the master bedroom. Backyard also have firepit on the second level of the backyard. Applicant stated she does not want to use the backyard for outdoor activity. Applicant made outside access inaccessible for children. Applicant stated she lives next door to a park and will use the park for outdoor activity for children in care. LPA reminded applicant when outside of facility, 100% supervision of children in care is required. LPA did not observed any bodies of water.

Applicant understands that children's personal rights should not be violated and no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries and requirements for assistant/substitute were also discussed. Fire drills must be conducted once every six months and documented. A Family Child Care Home packet was provided to and reviewed with the Applicant.

LPA discussed and reminded Applicant day care needs to be operated within the limitations and capacity of a Small Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.

LPA reviewed with Applicant the LIC311D, Forms/Records To Keep In Your Family Child Care Home, Children's Forms/Records, Facility Forms/Records, and Information to be Posted. *CON'T ON PAGE 3*
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: GATTI, CRYSTAL
FACILITY NUMBER: 073409330
VISIT DATE: 12/22/2022
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*PAGE 3*

This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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)/ (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.

LPA discussed the safe sleep regulations with Applicant, and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Website links for provider resources:


Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov.
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 platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication or email:childcareadvocatesprogram@dss.ca.gov

*CON'T ON PAGE 4*
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: GATTI, CRYSTAL
FACILITY NUMBER: 073409330
VISIT DATE: 12/22/2022
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*PAGE 4*

The following items to be completed prior to licensure:
1) Install Baby Gate to third level
2) Criminal Record Statement from Jaclynn Johnson
3) Tuberculosis (TB) clearance from Jaclynn Johnson
4) Measles documentation from Crystal Gatti

License will be pending until applicant submit required documentation to licensing, final file review and manager approval.

Exit interview was conducted with Applicant, Crystal Gatti. Applicant signed the report acknowledging receipts of documents.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4