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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409330
Report Date: 11/26/2024
Date Signed: 11/26/2024 12:04:59 PM

Document Has Been Signed on 11/26/2024 12:04 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:GATTI, CRYSTALFACILITY NUMBER:
073409330
ADMINISTRATOR/
DIRECTOR:		GATTI, CRYSTALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 852-7466
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 7DATE:
11/26/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Assistant Jenna VacaTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On November 26, 2024 at 9:15 am Licensing Program Analysts (LPAs) Janai McClain and Tasha Alexander met with assistant Jenna Vaca for a case management visit regarding another matter.

The licensee failed to report an incident when a child suffered an allergic reaction while at the facility. California Title 22 Regulations Section 102416.2 Reporting Requirements states that licensee shall report to the department any unusual event that occurs during the operation of the family child care home.

Exit interview conducted. Report and Appeal Rights provided.
Notice of Site visit must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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 11/26/2024 12:04 PM - It Cannot Be Edited


Created By: Janai McClain On 11/26/2024 at 09:24 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GATTI, CRYSTAL
FACILITY NUMBER: 073409330

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/03/2024
Section Cited
CCR
102416.2(b)(3)(B)

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102416.2 Reporting Requirements (b)The licensee shall report to the Department... (3)(B)Any injury to any child that requires medical treatment. This requirement has not been met as evidenced by:
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By 12/03/2024, Licensee will submit a written statement on how facility will come back into compliance. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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Based on interview, the licensee did not comply with the section cited above when licensee did not report to licensing that a child was hospitalized after consuming a known allergen which poses a potential risk to the health, safety or personal rights of children in care.
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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:Mayla Mendoza
LICENSING EVALUATOR NAME:Janai McClain
LICENSING EVALUATOR SIGNATURE:
DATE: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/26/2024


LIC809 (FAS) - (06/04)
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