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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376630016
Report Date: 08/15/2024
Date Signed: 08/15/2024 11:56:45 AM

Document Has Been Signed on 08/15/2024 11:56 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:DORESTANT, GERVERT FAMILY CHILD CAREFACILITY NUMBER:
376630016
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
08/15/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Gervert DorestantTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On August 15, 2024, at 10:35 AM, Licensing Program Analyst (LPA), Jo Ann Legaspi conducted an unannounced capacity increase inspection. Licensee Gervert Dorestant was advised of the inspection's purpose and granted LPA facility entry. Present in the home was the Licensee, Staff Venita Dorvilus Belony and four (4) children (ages 1.5 years, 2 years, 2 years and 4 years). Focus Language International translators 1642785 and 39576590 provided Haitian Creole translation.

On 07/29/2024, Licensee submitted an application (LIC 279) requesting a capacity increase. The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal on 08/07/2024 for fourteen (14) children. The provider has provided a written statement which declares they have at least one combined year of experience as a regulated small family childcare home operator. Landlord Consent is on file.

Licensee accompanied LPA on a tour of the home, as shown on the updated facility sketch. This downstairs, one (1) bedroom, one (1) bathroom apartment unit was toured and inspected. The following areas are used for childcare: the living room, the bedroom, the bathroom, and the fenced and shaded backyard. The off-limits area is the kitchen. Observation of kitchen cabinets within a child's reach revealed those cabinets contained no hazards to children. There are no bodies of water observed during time of visit. The fire extinguisher is rated 2A 10B: C. and is in the kitchen. The smoke and carbon monoxide detector met requirements and are operational. The last conducted and documented safety drill done in the facility was 08/07/2024. The Applicant provided a written statement confirming there are no firearms or other weapons in the home. The applicant also provided a written statement confirming no animals/pets cohabitate the home. The daycare schedule is everyday 12 AM to 11:59 PM.

Background criminal record clearances were verified and discussed. Licensee's pediatric First Aid and CPR certifications expire in June 2026.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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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: DORESTANT, GERVERT FAMILY CHILD CARE
FACILITY NUMBER: 376630016
VISIT DATE: 08/15/2024
NARRATIVE
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The Licensee was provided with the Ratio/Capacity Worksheet for a large family childcare home. The Licensee recognizes that the total amount of children simultaneously in the home also includes children who reside in the home. The Licensee acknowledged that if no assistant provider is present at a Large Family Child Care Home, then the Licensee shall comply with the capacity requirements for a Small Family Child Care Home.

The Applicant acknowledges that licensees shall be present in the home and shall ensure that children in care are supervised at all times. Applicant also acknowledged that when circumstances require a licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult, who is background cleared and associated to the license, to care for and supervise the children during their absence. Applicant
acknowledged that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

The Licensee shall ensure at least one staff member has a current course completion card in pediatric first aid and pediatric CPR issued by the American Red Cross, the American Heart Association, or by a training program that has been approved by the Emergency Medical Services Authority. Prior to employment or initial presence in the childcare home, all employees subject to a criminal record review shall: obtain a California clearance or a criminal record exemption as required by law or Department regulations or request a transfer of a criminal record clearance.

The applicant shall not employ a staff member if they have not been immunized against influenza, pertussis, and measles. Each employee shall receive an influenza vaccination between August 1 and December 1 of each year. The employee may submit a yearly written declaration attesting that they have declined the influenza vaccination. This exemption applies only to the influenza vaccine. Documentation of immunizations is to be maintained in the staff’s facility personnel record. The applicant shall provide each employee with a copy of the Notice of Employee Rights (LIC 9052) form. Each employee shall be requested to sign and date the notice form acknowledging receipt. A copy of the signed notice form shall be retained in the employee's personnel record. If the employee refuses to sign the notice form, a dated notation to that effect shall be retained in the employee's personnel record.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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: DORESTANT, GERVERT FAMILY CHILD CARE
FACILITY NUMBER: 376630016
VISIT DATE: 08/15/2024
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The Licensee is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248. Southern California Child Care Advocate (SCCCA) information was provided. The Licensee is already enrolled in this program’s email list through the CCLD website, thus electronically receives updated regulation information. Advocate information was provided: (916) 654-1541 and childcareadvocatesprogram@dss.ca.gov

In the areas that were evaluated, no deficiencies were observed. Licensure for a capacity of fourteen (14) of children is approved today (08/15/2024). A new license will be generated and mailed to the provider.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Licensee Gervert Dorestant.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC809 (FAS) - (06/04)
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