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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020130
Report Date: 06/24/2021
Date Signed: 06/24/2021 04:45:47 PM

Document Has Been Signed on 06/24/2021 04:45 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
198020130
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
06/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Licensee Amelia Gonzalez TIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced annual inspection to the above facility on 06/24/2021. LPA arrived at the facility at 2:10 PM and met with Amelia Gonzalez, Licensee who guided analyst on a tour of the facility. Per Licensee, there are four children that are currently enrolled. A current children’s roster was available for review. There were two children present upon arrival.
This is a one-story home which consists of 3 bedrooms, 3 bathrooms, kitchen, dining room, living room, front yard and backyard (fenced). The children use the bathroom in the hallway, living room and dining room areas and bedroom two. LPA observed that there is a fireplace in the living room and it is screened. Per Licensee, areas off limits to children and parents include: bedroom one and bedroom and detached garage. The licensee provides food for children in care.
Individuals who reside in the home were noted and discussed. Per Licensee, they currently do not have an assistant. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed childcare home. Licensee states that there are no firearms stored in the home.
All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. There is ventilation and heating; Licensee has an A/C wall unit installed in the living room and the on limits bedroom. The wall heater is not in use, the pilot on the wall heater is locked. Heating is provided by a portable heater. Safe toys play equipment and materials were observed.
Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. Detergents are kept outside in the laundry room, cleaning compounds are kept in a latched cabinet under the sink. Medications are kept in an upper cabinet in the hall way next to Bedroom one. Knives are kept in an upper cabinet. Although the kitchen is on limits, there is a safety gate at the entrance from the living room. Per Licensee, children only use the dining room which is connected to the kitchen. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020130
VISIT DATE: 06/24/2021
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The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on June 2021, as indicated on service tag. Smoke and carbon monoxide detectors were tested at 2:15PM and are operable. There is a smoke detector in the hall way and in bedroom one and the carbon monoxide detector is also located in the hallway.
Currently, children are using the front yard and the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided.
The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.
The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 05/01/2023. There are first aid supplies available in a cabinet in the dining room. LPA advised that if a child shows signs of illness he/she/they shall be separated from other children. Licensee stated bedroom 2 is used as the isolation room when needed while other children are in the living room.
Licensee states that she is not currently caring for infants. Licensee states that if an infant is enrolled, the infant will sleep in the living room where they are constantly supervised. Appropriate sleeping arrangements were discussed.. (one crib for each infant, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards were observed to be free of loose articles and objects. No objects were shall be hanging above or attached to the side of the crib. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee.
The licensee does not have proof of immunization against influenza, pertussis, and measles. LPA observed that the Licensee and assistant do not have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020130
VISIT DATE: 06/24/2021
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PG 3
Licensee states there are no pets on the premises. LPA did not observe any pets.
LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection.
Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.
LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.
Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.
Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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 advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. LPA also discussed the Provider Information Notices (PINS) on Safe Sleep Awareness: PIN 19-02-CCP, COVID FAQ - PIN 20-11-CCP, Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD.
The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/24/2021 04:45 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 06/24/2021 at 04:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020130

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2021
Section Cited
HSC
1596.8662(b)(2)

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1596.8662(b)(2)On and after January 1, 2018, a person who applies for a license to be a provider of a child day care facility shall complete the mandated reporter training...shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Per Licensee, Mandated reporter will be submitted by 7/9/21
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This requirement is not met as evidenced by: Licensee did not complete Mandated reporter training. This poses a potential risk to children in care
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Type B
06/30/2021
Section Cited
HSC1597.622(a)(1)

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1597.622 Employee and Volunteer Immunization.Commencing September 1, 2016, a person shall not be employed at a family day care home if he or she has not been immunized against influenza, pertussis, and measles.
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Per Licensee proof of immunization record will be submitted by 7/23/21.
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This requirement was not met as evidenced by: Licensee did not have proof of influenza, pertussis or measles available at inspection. This poses a potential risk for children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brandi VanOosten
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2021


LIC809 (FAS) - (06/04)
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