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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418370
Report Date: 10/22/2021
Date Signed: 10/22/2021 02:59:28 PM

Document Has Been Signed on 10/22/2021 02:59 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:GALLARDO, ADRIANAFACILITY NUMBER:
013418370
ADMINISTRATOR:GALLARDO, ADRIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 938-7886
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
10/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:TIME COMPLETED:
03:25 PM
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On October 22, 2021 at approximately 11:30am Licensing Program Analyst (LPA) Russ Haderer met with licensee Adriana Gallardo for the purpose of conducting an unannounced annual inspection for health and safety. Living in the home is the licensee, her TB test and fingerprint cleared husband. Present for today’s inspection was licensee and her fingerprint and TB cleared sister and three children in care (1 infant, 1 two year old and 1 three year old). The hours of operation are Monday-Friday, 8:00am to 6:00pm.


The facility is a single-story home with 3 bedrooms and 2 bathrooms, a living room, family room, kitchen, attached 2-car garage front, side and back yards. On the side of the home there is an additional space used for the day care area which consists of 2 large play/activity areas, a kitchenette, a bathroom and an enclosed small outdoor yard. Access to the day care area is to the left of the garage, which has its own separate gated entrance.

Toxins, medicines, and hazardous items were inaccessible during today's inspection. Per the licensee, the ISOLATION AREA will be in the on-limits classroom away from the other children in care.

On-limit-areas include: The daycare area on the side of the home consisting of the 2 large playrooms, kitchenette, bathroom, the small enclosed side yard and inside the main home in the family/TV room, that the children may use while supervised to watch a program.

Off-limit-areas include: The main home and all 3 bedrooms and 2 bathrooms, the living room, kitchen, attached 2-car garage and back yard. All off limit areas are inaccessible by closed and/or locked doors and visual supervision.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GALLARDO, ADRIANA
FACILITY NUMBER: 013418370
VISIT DATE: 10/22/2021
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There were ample age appropriate toys that were observed to be safe and in good condition. The home and the day care area and rooms are neat and clean, with heating and ventilation for safety and comfort. LPA did not observe any hazardous materials, or toxins accessible to children on the premises during the inspection.

There is a fully charged 3A40BC fire extinguisher located in the kitchenette on the left side of the stove. The facility has 2 working (tested) dual smoke and carbon monoxide detectors. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills at least twice a year, and the log indicates a drill was conducted 7/16/2021. All required licensing documents are posted and visible for public review.

At 12:50pm, children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. All files were complete and the licensee is in ratio today. One recently admitted child's parents filled out but did not sign the personal and parents rights forms. All other children's files were complete.

The licensee’s Pediatric CPR/First Aid certificate is current and expires 2/24/2022. Mandated reporter training was expired on 1/1/2021. Licensee, and all adults living in the home are in compliance with immunization law which pertains to day care providers,

LPA reminded the licensee of the following: Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.



The licensee owns the property but does not carry liability insurance. Parents have signed forms acknowledging there is no liability insurance, forms present in all children's files.

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
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GALLARDO, ADRIANA
FACILITY NUMBER: 013418370
VISIT DATE: 10/22/2021
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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.

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 [email protected]. 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/inspection-process.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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.

There were no deficiencies issued during today’s inspection: This report will remain on file for 3 years.

A review of operating safely during the Covid-19 pandemic (RAST) was conducted.



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

Exit interview conducted and report was reviewed with the licensee Adriana Gallardo.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
LIC809 (FAS) - (06/04)
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