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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100482
Report Date: 09/14/2023
Date Signed: 09/14/2023 11:43:48 AM

Document Has Been Signed on 09/14/2023 11:43 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
SAN DIEGO N. CC RO, 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: 12CENSUS: 11DATE:
09/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Nicole GerbargTIME COMPLETED:
11:55 AM
NARRATIVE
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Licensing Program Analyst (LPA), Saraliz Velando conducted an unannounced Annual Licensing Inspection. LPA was greeted at the front door by licensee, Nicole Gerbarg. LPA was granted entry after identifying herself and disclosing the purpose of her visit. There were 11 children present. Licensee is using the following areas for daycare: Back yard, Side Yard, Master Patio, and Bathroom 2. The following areas are off-limits to children: Bedroom 1-3, Master Bathroom, Front Yard, Patio, Living room, Kitchen, and Garage. These areas are inaccessible to children by gates and constant supervision. Children are provided a safe, healthful, and comfortable environment, furnishings, and equipment. Business Hours are Monday, Tuesday, and Thursday, 8:30am-12:30pm.

There is a fire extinguisher in the garage area that meets regulations. LPA did not observe any bodies of water on the premises. Licensee stated there are no weapons or ammunition stored on the premises and LPA did not observe any.

Storage for poisons, detergents, cleaning solutions, medications are inaccessible by doorknob covers for off limit rooms or safety latches. Licensee provided a fire/disaster drill log that shows last drill was conducted on 5/1/23. The home is kept clean and orderly with heating and ventilation for safety and comfort.

Licensee has no infants currently on her roster. Pediatric CPR and First Aid card expires July 2024. Licensee has a Mandated Reporter training certificate that expires August 2024. There is a working telephone and email address.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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 09/14/2023 11:43 AM - It Cannot Be Edited


Created By: Saraliz Velando On 09/14/2023 at 10:17 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GERBARG, NICOLE FAMILY CHILD CARE
FACILITY NUMBER: 376100482

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that licensee and all assistants do not have proof of flu shot or letter of declination in their file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2023
Plan of Correction
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Licensee stated she will provide proof of flu shot or letter of declination to the dept by 9/22/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Renesha Askew
LICENSING EVALUATOR NAME:Saraliz Velando
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023


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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GERBARG, NICOLE FAMILY CHILD CARE
FACILITY NUMBER: 376100482
VISIT DATE: 09/14/2023
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Licensee or facility representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain 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.

LPA discussed the safe sleep regulations with licensee or facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee for facility representative 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.

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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to: inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Deficiency was cited on LIC809-D.

Exit interview was conducted and report was reviewed with licensee, Nicole Gerbarg. Copy of report and Appeal Rights was given. A notice of site visit was posted and must remain for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
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