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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500499
Report Date: 09/28/2021
Date Signed: 09/28/2021 11:08:51 AM

Document Has Been Signed on 09/28/2021 11:08 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:GROSS GAITAN, MARITZAFACILITY NUMBER:
574500499
ADMINISTRATOR:GROSS GAITAN, MARITZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 296-2912
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/28/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Maritza Gross GaitanTIME COMPLETED:
11:25 AM
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On September 28, 2021, at 09:45 a.m. Licensing Program Analyst (LPA) Elvira Sierra conducted a Prelicensing inspection for the purpose of change of location and met with Licensee, Maritza Gross Gaitan. Licensee was previously license under facility # 573622786. Fire clearance was granted for a capacity of 14 children on 09/21/21. Facility hours of operation will be M-F from 06:00 a.m to 06:00 p.m. All individuals residing in the home have obtained a criminal record clearance.

At 10:10 a.m. a health and safety inspection was conducted and the following was observed. Home is a 5 bedrooms and 3 bathrooms two story home. The Off-limits areas include; Entire upstairs, garage,front yard, driveway and left side area of the backyard. Licensee acknowledged that children may never enter these off-limit areas. The home is equipped with at least one working carbon monoxide and a smoke detector. LPA observed a fully charged fire extinguisher that meet minimum size requirements. Stairs leading to the second floor are properly barricaded. Sharp utensils and knives are inaccessible to children. Homes has sufficient napping equipment for the children in care. Licensee stated she will provide meals. Outdoor play space is fenced for supervision and areas under climbing equipment is adequately cushioned. Required postings were observed. Per Licensee there are no weapons in the home and bodies of water were not observed. Licensee was advised that prior to taking alterations or additions to the home or grounds, the Licensee shall notify the Department of the proposed changes.

Licensee has a current CPR that expires on 03/12/2022. Mandated Reporter Training expires on 10/20/22. Licensee understands that the training must be updated every 2 years. LPA advised that baby walkers, bouncers, jumpers, and similar items are not allowed in a Family Child Care Home.

Report continues subsequent page 809C---
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499
VISIT DATE: 09/28/2021
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Licensee 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.

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 discussed the safe sleep regulations with Licensee 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 [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.

Large Family Child Care License is approved and will be effective as of today, 09/28/21 at the new location.

Exit interview conducted and report was reviewed with the Licensee, Maritza Gross Gaitan.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
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