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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700351
Report Date: 10/18/2022
Date Signed: 10/18/2022 01:15:00 PM

Document Has Been Signed on 10/18/2022 01:15 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
197700351
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
10/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Hilda GonzalezTIME COMPLETED:
01:29 PM
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Licensing Program Analyst (LPA) Justin Dorsey met with Licensee, Hilda Gonzalez and Assistant Jeanelly Gonzalez, who guided analyst on a tour of the facility for the One Year Required Inspection. This is a one story 3 bedroom, 2 bathroom home with kitchen, dining room, living room, family room, laundry room and garage. There is no pool on the premises. Upon arrival LPA observed 7 children with the licensee and assistant.

Physical Plant: Main care is provided in the family room. Children use the bathroom in hallway near the homes bedrooms. Children have access to the family room, children's bathroom and backyard. Off limit area all of the homes bedrooms, kitchen, dining room, laundry room and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (locked under the sink), medicines (locked high in a kitchen cabinet) and hazardous items (sharp knives inaccessible on top of refrigerator) that can pose a danger to children. Fireplace is screened. The home has safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, and Fire Extinguisher (2A10BC) are in operable condition. Per Assistant Jeanelly no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary near the family room. Per assistant Jeanelly there are no weapon/firearms in the home.

The home conducted a fire and earthquake drill 10/18/22. LPA Dorsey observed the drill was documented.

Bathroom: Shower/tub are free of hazards (child care bathroom). Toilet and faucet is clean and operable.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700351
VISIT DATE: 10/18/2022
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Kitchen: Sharp utensils are inaccessible. Per licensee breakfast, AM snack, lunch, PM snack, and dinner are provided. LPA reminded licensee If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies are locked under the sink. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard is safe for children and completely fenced. The backyard has grass and concrete areas for children to play. LPA observed the toys in the backyard to be in safe condition. There are 2 off limit areas on the left and right side of the backyard which are made inaccessible by gate. There are 2 dogs in the home and backyard.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expire 04/06/21. Mandated Reporter was completed 08/24/21. Children nap on cots in the family room.

Documents discussed: Title 22 102416.1 Personnel Records, LIC 9040, LIC 9150, Safe Sleep PIN 20-24-CCP, LIC 9227 and Infant Sleep Log.

Assistant Jeanelly 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.

LPA discussed the safe sleep regulations with Assistant Jeanelly 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 Assistant Jeanelly 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.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700351
VISIT DATE: 10/18/2022
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A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Assistant Jeanelly Gonzalez.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
LIC809 (FAS) - (06/04)
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