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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100482
Report Date: 09/30/2021
Date Signed: 09/30/2021 10:25:16 AM

Document Has Been Signed on 09/30/2021 10:25 AM - 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GERBARG, NICOLE FAMILY CHILD CAREFACILITY NUMBER:
376100482
ADMINISTRATOR:NICOLE GERBARGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 676-7444
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
09/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Nicole GerbargTIME COMPLETED:
10:35 AM
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On September 30, 2021 at 8:40 a.m. Licensing Program Analyst (LPA), Leilani Curtis visited the facility to conduct an unannounced Annual Inspection. LPA also addressed the licensee’s request to add the master patio to the areas licensed for daycare. Upon arrival LPA met with Licensee Nicole Gerbarg. Also present were helpers Sheila Gately and Kerstin Guba. There were 8 children in care, none of whom were infants. Facility was observed operating within ratio and capacity. LPA conducted a tour of the home inside and outside per facility sketch. Licensee is using the following areas for daycare: living room, kitchen, bathroom #2 and enclosed rear yard. LPA inspected the master patio (patio #1) per licensee’s request and observed that it is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3 and it will now be used as a licensed area. The licensee is reminded to follow the manufacturer’s instructions when using the hammock swings attached to the house beams on the master patio and the Little Tikes swing attached to the house beams in the rear yard. Off-limits areas include: bedroom #1, bedroom #2, bedroom #3, bathroom #1 (located in bedroom #1), patio #2, pantry and garage.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Home is clean, orderly and has adequate ventilation. Children’s toys and play equipment are available and observed free of hazards. There are no stairs in the home. There is a working telephone/email address. All cleaning compounds, detergents, medications, and poisons are made inaccessible through latches, locks, and/or placed up on high surfaces. The fireplace is screened. The fire extinguisher and smoke and carbon monoxide detectors are operational. Licensee states there are NO firearms or other weapons in the home. The outdoor play area is fenced and free of hazardous items. There are no existing bodies of water present. Children records were reviewed for Emergency Information. There are no new adults living or working in the home over the age of 18 years. All adult residents and helpers have submitted or been cleared for criminal record and child abuse index clearances or exemptions. Pediatric CPR and First-Aid certificates are valid through 7/25/22 for the licensee. Helper Sheila Gately’s CPR/First Aid certificate expires 8/15/22 and helper Kerstin Guba’s CPR/First Aide certificate expires 6/12/23. The last documented emergency drill occurred on 6/3/21. Licensee and helpers have completed the Mandated Child Abuse Reporting-per AB1207. LPA reviewed certification and they are in compliance. Immunization records per SB792 were reviewed and in compliance for licensee and her helpers.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2021
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GERBARG, NICOLE FAMILY CHILD CARE
FACILITY NUMBER: 376100482
VISIT DATE: 09/30/2021
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LPA reviewed the following with Licensee: Recently Approved Safe Sleep Regulations PIN 20-24-CCP, Updated Coronavirus 2019 Industry Guidance PIN 21-18-CCP, California Department of Public Health Guidance for Child Care Providers dated 6/29/21, Car Seat Law, emergency drills, SIDS, and Shaken Baby Syndrome. Licensee is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation. Licensee is aware that interference with a child’s daily functions, corporal punishment, physical and mental abuse is not allowed. Licensee is reminded to make anything that reads, "Keep Out of Reach of Children" inaccessible to children.

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.

No deficiencies are cited.

LPA reviewed this report with Licensee and provided a copy of her Appeal Rights (LIC 9058 01/16). Her signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit.

Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov.
Duty Officer: (619) 767- 2248, Monday thru Friday 8am-5pm.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website. Please go to www.ccld.ca.gov and click on Child Care, go under Quick Links and Quarterly Updates, click on “Receive Important Updates” then enter your email address and choose which program(s) you would like to subscribe to and click “subscribe”.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
LIC809 (FAS) - (06/04)
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