<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406170
Report Date: 06/20/2023
Date Signed: 06/21/2023 08:30:56 AM

Document Has Been Signed on 06/21/2023 08:30 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GALLEGOS, TERESAFACILITY NUMBER:
444406170
ADMINISTRATOR:GALLEGOS, TERESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 359-6097
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 8DATE:
06/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Teresa GallegosTIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Elizabeth Berumen conducted a Required - 1 Year required inspection. LPA notes that the home is located on an ally behind Madison Street and not on Lincoln Street. LPA met with Licensee, Teresa Gallegos and explained the nature of today's inspection. LPA observed eight day care children; 3 preschoolers and 5 school age children. Licensee's husband, son, Gustavo and daughter, Yesenia Gallegos were also present during the inspection.
Licensee states there are four adults living in the home; herself, her husband (Jorge Gallegos Garnica), adult son (Gustavo Gallegos) and adult daughter (Alejandra Gallegos).
The day-care is open Monday thru Saturday from 6:00 AM to 6:00 PM. LPA observed a current children's roster (LIC9040). Copy of children's roster was obtained during the inspection. The last Fire/disaster drill was conducted on April 21, 2023. LPA observed a fully charged 2A10BC fire extinguisher that was serviced on February 4, 2023. The smoke/carbon monoxide detector was tested and proved to be functioning. Wall heater is barricaded. Licensee states that there are no weapons or firearms in the home. Licensee has two pet dogs that are kept outside in the back yard.

LPA inspected the on limit indoor and outdoor areas of the home. LPA observed barricaded stairs. Off limit areas inside the home: entire upstairs area (3 bedrooms and one bathroom). Off limit area outside: backyard. Licensee uses the front yard area for outdoor play space. Storage shed in front area is locked and off limits to children.

Cleaning products, sharp objects, and other items that are dangerous to children were stored inaccessible. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. The children's bathroom is clean, sanitary, and operable. The bathroom cabinet has a lock. The home has a working telephone. No bodies of water were observed.
Continuation on next page:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GALLEGOS, TERESA
FACILITY NUMBER: 444406170
VISIT DATE: 06/20/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA reminded licensee 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 reviewed 8 children’s files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), and Immunization Records (PM 286/CDPH 286).
Licensee's Mandated Reporter Training was completed on May 10, 2022. Licensee has immunization in Measles, Pertussis; declines the influenza vaccine. Licensee's CPR & First Aid expires on March 6, 2025. LPA reviewed two assistant files.

Incidental Medical Services (IMS) policy was discussed. Licensee states that is currently not proving or planning to administer any medication at this time. 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 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 with Licensee, Teresa Gallegos.

As a result of today's inspection, no deficiency cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2