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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406108
Report Date: 07/09/2024
Date Signed: 07/09/2024 12:22:02 PM

Document Has Been Signed on 07/09/2024 12:22 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GALLO, ELEODORAFACILITY NUMBER:
444406108
ADMINISTRATOR/
DIRECTOR:		GALLO, ELEODORAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-6762
CITY:FREEDOMSTATE: CAZIP CODE:
95019
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 0DATE:
07/09/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Eleodora GalloTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual inspection to the home today. LPA met with Eleodora Gallo, licensee and explained the nature of today's inspection to her. Days and hours of operation are Monday to Saturday from 6:00 AM to 6:00 PM. Licensee stated the adults that reside in the home are licensee Eleodora, and her adult children Mario, Angelica, Guadalupe Jr. and Omar. Licensee stated a minor grandchildren age 14 years old reside in the home. LPA observed there were not children present in the home during the inspection, Certification for CPR and First Aid Card for Licensee are current and will expire on 9/17/24. Licensee stated she will submit an application for downsize her large license. LPA provided her with a blank Lic279.
LPA toured the indoor and outdoor areas of the home during today's inspection. LPA took a picture of the children's roster today and it is current. LPA reviewed four children files and observed files are complete. LPA observed that Licensee has not conducted or documented a fire drill during the last six months. Last fire drill was documented on March 2023.
The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children.
LPA inspected the indoor and outdoor areas during today's inspection. There are no stairs inside the home. Off limit areas inside the home: Three bedrooms, one bathroom, garage, LPA notes that licensee's daughter and her family live in the off limits garage. Off limit areas outside the home: A two rooms studio- a separate living area in the backyard- where licensee's two adult sons live, and a shed where licensee's late husband used to have a pool table.
LPA observed a fully charged 3A40BC fire extinguisher last time serviced on 6/19/24 working smoke & carbon monoxide detectors, no bodies of water, and fenced backyard. LPA observed the home does not have wall heaters, or bodies of water. LPA observed a barricaded fireplace located in the living room. LPA observed sufficient materials, toys, and play equipment for the day care children. Licensee is currently using the front yard for the children outdoor activities. Licensee stated will submit an updated sketch of the facility. The Licensee states that there are no weapons in the home. LPA observed there is a dog in the home and it is vaccinated. Cleaning Products, toxic agents, medications, and similar items were inaccessible to children.
*******************Report dated 7/09/24 continues in page 2.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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Document Has Been Signed on 07/09/2024 12:22 PM - It Cannot Be Edited


Created By: Fermin Campos-Jaramillo On 07/09/2024 at 11:34 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GALLO, ELEODORA
FACILITY NUMBER: 444406108

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above, Licensee has not documented one fire drill since March 2023, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/24/2024
Plan of Correction
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Licensee will conduct and document a fire drill and will submit a copy of the log not later than 7/24/24
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:Susy Cervantes
LICENSING EVALUATOR NAME:Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024


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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GALLO, ELEODORA
FACILITY NUMBER: 444406108
VISIT DATE: 07/09/2024
NARRATIVE
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Report dated 7/09/24 continues from page 1

According with the SB792, Licensee has proof of immunization for herself for pertussis, measles, and influenza.
Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her current capacity options and she understands that she cannot have more than 14 children in the home at any time, ratio (age of the children) must be observed, and a helper must be present whenever there are more than 8 children in care. Licensee understands in absence of a helper her license capacity is reduced to 8 only and ratio must be observed. The Licensee states that she does transport children via vehicle and that she understands that children cannot be left in parked vehicles unattended at any time. Licensee uses redirection and communication with children as a form of discipline.

Department website: www.ccld.ca.gov provided to Licensee.
LPA observed licensee has completed the mandated reporter training on 5/16/23. Licensee understands the training is mandatory for all the adults in her home in contact with the children in care and training shall be renewed every two years. LPA provided the training website www.mandatedreporterca.com to the licensee for additional information on the online training.

A review of staff records on 7/02/24 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee Eleodora Gallo was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a 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 and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

************** Report dated 7/09/24 continues on page 3.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GALLO, ELEODORA
FACILITY NUMBER: 444406108
VISIT DATE: 07/09/2024
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Report dated 7/09/24 continues from page 2.

LPA also informed licensee 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/process.

Exit interview conducted and report was reviewed in Spanish with the licensee Eleodora Gallo.

One type B deficiency was cited today.

Failure to comply with the Plan Of Corrections (POC) by the due date on LIC809D shall result in an immediate civil penalty of $100 per day per each deficiency.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
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