Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409221
Report Date: 08/17/2015 12:00:00 AM
Date Signed 08/17/2015 03:58:13 PM

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:LARA, GABRIELAFACILITY NUMBER:
434409221
ADMINISTRATOR:GABRIELA LARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 843-8720
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 8DATE:
08/17/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Gabriela LaraTIME COMPLETED:
04:10 PM
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(3) Licensing Program Analyst (LPA) Elizabeth Berumen conducted an unannounced random visit to the home today. LPA met with Licensee, Gabriela Lara and explained the nature of today's visit to her. LPA also observed Licensee's husband, her 13, 12 and 4 year old children and 5 day care children (3 infants and 2 pre-school children). Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM. The adults that reside in the home are the Licensee and her husband. Licensee's certifications for CPR and First Aid are current and expire in March 2016.

LPA toured the indoor and outdoor areas of the home during today's visit. LPA reviewed a Child Care Facility Roster, updates were made to the roster during today's visit. LPA reviewed a fire disaster drill, last drill practiced on March 13, 2015. LPA reviewed four children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. The Licensee's phone number changed, her new number is (408) 510-4829. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters inside the home. Off limit areas in the home are entire upstairs (4 bedrooms & two bathrooms), laundry room downstairs and garage. LPA observed barricaded stairs and barricaded fire place.

LPA observed a fully charged 3A40BC fire extinguisher and working smoke detector. Gabriela does not have a carbon monoxide detector because she was not aware that she needed one. LPA informed her that a carbon monoxide detector is required, she said she'll purchase and install one. Gabriela is not using the backyard. LPA observed that the backyard is fenced and there is a pool that meets title 22 requirements. Front yard is being used. The Licensee states that she does not have any weapons. Gabriela has a pet dog. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2015
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LARA, GABRIELA
FACILITY NUMBER: 434409221
VISIT DATE: 08/17/2015
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 08/17/2015):

A review of staff records on August 17, 2015 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

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 capacity options and she understands that she cannot have more than 14 children in the home at any time with a qualified assistant present. When she is alone her license reverts back to a small license. The Licensee states that she does not transport children via vehicle; however, she understands that children cannot be left in parked vehicles unattended at any time.


LPA conducted an exit interview with the Licensee prior to the conclusion of today's visit and requested that the Licensee submit a receipt of the purchase of her carbon monoxide detector to LPA.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2015
LIC809 (FAS) - (06/04)
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