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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376630172
Report Date: 11/20/2024
Date Signed: 11/20/2024 06:03:42 PM

Document Has Been Signed on 11/20/2024 06:03 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:PETIT-LOUIS, ESTIVERNE FAMILY CHILD CAREFACILITY NUMBER:
376630172
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/20/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:35 PM
MET WITH:Estiverne Petit-LouisTIME VISIT/
INSPECTION COMPLETED:
06:05 PM
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On 11/20/24 at 4:35PM, LPA, Luigi Gargaro, conducted an announced prelicensing inspection for a relocation with the applicant, Estiverne Petit-Louis, to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. The one story residential unit was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher and smoke and carbon monoxide detectors meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children.

The applicant was asked whether he had any bodies of water or weapons in the home and he replied no. CPR and First Aid expire on April of 2025 for the applicant. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Applicant rents the home and provided proof of control of property in the form of a lease agreement that he submitted with his original application.

Applicant will be using the following rooms for childcare: the kitchen, the living room area and day care bathroom located immediately off the living room. Off limits are the three home bedrooms with the remaining two inclusive bathrooms. The bedrooms are made off limits with door locks. The home as a wall heating unit that applicant attests is non-operational. Applicant understands that if it ever is made operational, he will be required to install a safety gate or other security device that will make the heater inaccessible to children in care. The applicant has sufficient toys and equipment available.

The home has a backyard area that is a shared one with the other two separately addressed units that are located on the property. Applicant states he wants the yard area to remain off limits until he is able to install separation fencing to have his own yard area. Until then, the applicant states he will take children to a local park for outdoor activity whenever necessary. The yard is made off limits with a latching sliding door.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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: PETIT-LOUIS, ESTIVERNE FAMILY CHILD CARE
FACILITY NUMBER: 376630172
VISIT DATE: 11/20/2024
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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 and applicant discussed California Megan's Law and he provided applicant with the website address: www.meganslaw.ca.gov for him to review information regarding her facility on a regular basis. Unusual Incident Reports may be e-mailed to: SDIncidentReports@dss.ca.gov.

Applicant was reminded of requirements for children’s records, child abuse and unusual incident reporting, immunizations, adults living or working in the home and associated civil penalties, shaken baby syndrome, and SIDS. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care.

No corrections are required and a license for 8 will be issued today at this new location.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC809 (FAS) - (06/04)
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