198020311-6-9-2021-33-CC-AGOK-C3U2HG-20210609172444

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020311
Report Date: 06/09/2021
Date Signed: 06/09/2021 05:24:51 PM

Document Has Been Signed on 06/09/2021 05:24 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	GAMBOA FAMILY CHILD CARE		FACILITY NUMBER:	198020311
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	06/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Esther Gamboa		TIME COMPLETED:	05:30 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	On 6/9/2021, at 2:15 p.m., Licensing Program Analyst (LPA) Alanna Gontarek conducted an unannounced annual inspection to the above facility. LPA met with Esther Gamboa, Licensee who guided analyst on a tour of the facility indoors and outdoors. Per Licensee, there are 8 children that are currently enrolled. The Licensee is within the conditions, limitations, and capacity specified on the license. A current children’s roster was available for review. There were 6 children present upon arrival. Hours of operation are: Monday to Sunday from 5:00 a.m. to 9:30 p.m. LPA observed staff and children wearing face masks and keeping a distance of 6 feet social distance due to COVID-19 preventative measures. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, living room #1, living room #2/ daycare room, front yard and backyard (fenced) with a pool. Daycare areas include: the bathroom at the end of the hallway, living room #1/ daycare room, and bedroom #2. Per Licensee, areas off limits to children and parents include: Front bedroom #1, bedroom #3 (Licensee's room), kitchen, front hallway storage closet, garage, backyard, and front yard. LPA observed that there is a fireplace in the off-limit living room #2, and is barricaded. The licensee provides fresh perishable and non-perishable food in the home in good quantity, and quality, to meet the needs of the children for the next 3 meals and between meal snacks. The licensee states that 1 additional adult and 1 child currently live in the home. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed Child Care home. Licensee states that there are no firearms, or firing pins, stored in the home. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via cellphone that is used and the cellphone stays at the facility during operation hours. There is ventilation and heating (central). Each school age child has individual storage space. The following was observed and reviewed during this inspection.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Alanna Gontarek
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GAMBOA FAMILY CHILD CARE	FACILITY NUMBER: 198020311
	VISIT DATE: 06/09/2021

NARRATIVE

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Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. LPA observed cleaning compounds in a storage closet, and poisons stored in a container, in the off-limit garage. LPA observed the garage to be key locked. The poisons are stored on a high shelf, and are inaccessible to children in care. The licensee states will lock poisons and understands that storage areas for poisons must be locked with a key or combination lock. Per licensee, will install a combination or key lock today. The restroom that children use was observed to be safe and sanitary. LPA observed living room #2 made inaccessible by a key locked door, and leads out to the pool. LPA advised Licensee to install door cover or replace door knobs leading to living room #2 from living room #1. LPA observed a sliding glass door which leads out to the pool from living room #2. LPA observed the sliding glass door to have a latch along the left side of the doors and a latch at the top of the doors, making back yard inaccessible. LPA observed kitchen to be made inaccessible by a latching child-proofed gate. LPA observed knives and cleaning compounds to be stored in upper cabinet above sink. LPA observed a high chair in living room #1.

Fireplaces and open face heaters are inaccessible to children. LPA observed fireplace to be in off-limit living #2, and is barricaded. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 08/07/2020, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable. Last fire drill was documented on 4/24/2021, and earthquake drill was documented on 4/23/2021.

The home is observed to be clean and orderly. LPA observed toys available to children. Children have individual cots, and also clean linens, blankets, and pillows that are in good condition located in off-limit hallway storage closet. LPA observed a play yard (Pack N' Play) stored in the hallway storage closet.

Currently, children are not using the back yard for outdoor play time. Both yards are off-limits. The licensee states that supervision is always provided. LPA observed a pool at 2:40 p.m. to be inaccessible by mesh fencing, key locked and latched, and gate swinging away from pool, specified by regulation, to children in care.

Licensee has 2 dogs on the premises and they stay in the off-limit side yard during operating hours.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Alanna Gontarek
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GAMBOA FAMILY CHILD CARE	FACILITY NUMBER: 198020311
	VISIT DATE: 06/09/2021

NARRATIVE

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The licensee has completed training on preventive health practices on 1/10/2019, and Pediatric CPR and First Aid on 3/06/2021, expiring 3/2023. LPA observed first aid supplies located in kitchen and a first aid back pack located at entryway. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

Children’s records were reviewed, including emergency information and were observed to be complete.
LPA observed that the Licensee has proof of immunization record. LPA observed the Mandated Reporter Training (AB 1207) expiring on 7/5/2021 for Licensee.

LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files were reviewed during this inspection.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Licensee states currently does not care for infants. LPA discussed infant requirements: Every infant in care needs to have a crib or play yard who is unable to climb out of the crib or play yard. All equipment must meet the US Consumer Product Safety Commission safety standards. Each crib and/or play yard must be free from loose articles and objects. There should be no objects hanging above or attached to the side of the crib. The cribs and play yards must not hinder the entrance or exit to and from the space they are sleeping in. Mattresses must be firm and covered with a fitted sheet that is appropriate to the mattress size. Each infant must have their individual bedding that is washed weekly as required. Soiled bedding is replaced when wet or soiled and is placed in an area inaccessible to infants. Pacifiers must not be attached to anything and need to be labeled. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping. LPA advised the licensee to sleep infants where they can always be directly supervised and advised the licensee against sleeping infants in a

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Alanna Gontarek
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GAMBOA FAMILY CHILD CARE	FACILITY NUMBER: 198020311
	VISIT DATE: 06/09/2021

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separate room. Licensee states that if an infant is enrolled, the infant will sleep in living room #1 where they are constantly supervised. Licensee states that she is not currently caring for infants. LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was explained and issued to the Licensee when/if an infant is enrolled. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained, including 15-minute check log. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

The licensee states that she does not provide IMS. Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, 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 advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

Capacity Handout (Small & Large) was provided during this inspection.
LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home, capacity worksheet, Sleep Regulations (Title 22)

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

Exit interview was conducted with Esther Gamboa, Licensee at 5:15 p.m. LPA explained and provided a copy of this report (LIC 809), Appeal Rights, and Notice of Site Visit. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Alanna Gontarek
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

LIC809 (FAS) - (06/04)

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