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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610575
Report Date: 11/09/2023
Date Signed: 11/09/2023 01:13:38 PM

Document Has Been Signed on 11/09/2023 01:13 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GONZALEZ, MARTHA FAMILY CHILD CAREFACILITY NUMBER:
136610575
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
11/09/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Martha GonzalezTIME COMPLETED:
01:15 PM
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On 11/09/2023 at 12:00 PM Licensing Program Analyst (LPA), Dana Stevens conducted an unannounced Inspection for the purpose of capacity increase. LPA met with Licensee, Martha Gonzalez, disclosed the purpose of the inspection and was granted entry into the facility. There were five children present at the time of this inspection, one infant under 2 years. Facility was in substantial compliance with capacity/ratio requirements. Licensee accompanied LPA throughout the inspection of this 4 bedroom, 2 bathroom home. Applicant will use the following areas for child care: daycare area and one bathroom. Side yard is used for outdoor activities and is properly fenced and Licensee provides total supervision at all times. Off limits areas include: back yard, kitchen, all bedrooms and one bathroom. These areas are made inaccessible with doorknob covers, safety latches and safety gate. Hours of Operation are Monday through Friday 6:00 AM - 6:00 PM.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements.  The licensee has toys, play equipment and materials available. Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.  Licensee's First Aid and CPR certification expires 06/2025. Licensee's most recent Mandated Reporter training was completed 05/2023.Assistant's CPR and FIrst Aid certification expires 09/2025. Assistant completed Mandated Reporter training 09/2023. Licensee and assistant have required immunization. Facility roster was available and updated. A total of 7 children are currently enrolled. Children's file were reviewed and found complete. The last fire and disaster drill was completed 10/07/2023.



There is one crib or play yard for each infant who is unable to climb out of the crib or play yard.  Cribs or play yards are free from all loose articles and objects. The provider physically checks on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age.  The provider places infants up to 12 months of age on their backs for sleeping.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GONZALEZ, MARTHA FAMILY CHILD CARE
FACILITY NUMBER: 136610575
VISIT DATE: 11/09/2023
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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

No deficiencies cited.

Increase in capacity is granted effective this date. Exit interview conducted and copy of this report provided to Licensee, Martha Gonzalez. Notice of Site Visit must be posted for 30 days,

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023
LIC809 (FAS) - (06/04)
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