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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020811
Report Date: 07/15/2024
Date Signed: 07/17/2024 11:30:27 AM

Document Has Been Signed on 07/17/2024 11:30 AM - 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
198020811
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
07/15/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:35 PM
MET WITH:Evelia GonzalezTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On 7/15/2024 at 12:35 pm, Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced inspection visit for the above facility. Covid risk assessment was conducted. LPA met with Licensee, Evelia Gonzalez. During today’s inspection LPA observed 5 children in care. A facility roster was available. Per Licensee, operating hours are from Monday – Friday 7:00 am – 4:30 pm and cares for children ages Birth to 12 years of age. The licensee provides breakfast, AM/PM snack, and lunch for the children in care. Licensee provides all meals but is not part of a food program. The facility is currently a small family childcare but Licensee stated that she is interested becoming a large facility in the near future.

This is a one-story single-family home which consists of a living room, dining area, family room, kitchen, garage, front yard, back yard, 4 bedrooms and 3 bathrooms. Areas used by children were inspected as follows: family room, 1 bedroom, 1 bathroom, and back yard. Child who becomes ill will be kept in the bedroom until parents pick-up.

Areas off limits include: 3 bedrooms, 2-bathrooms, front yard, living room, kitchen, dining area and garage.

The licensee states that 4 adults currently are living in the home and no minor children. LPA did not observe any bodies of water around the property of the home.

Licensee states that there are no firearms stored in the home. The home was inspected for safety, comfort, cleanliness, ventilation, and telephone service. Fire and safety drills must be performed every 6 months and documented for review by the Department. Licensee conducted an Emergency Drill in March 2024, and was documented. No one smokes at the family childcare home. There is currently a fireplace, but it is locked with a glass door and per Licensee it is not being used.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2024
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 6
Document Has Been Signed on 07/17/2024 11:30 AM - It Cannot Be Edited


Created By: Carolyn Tuba On 07/15/2024 at 03:28 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020811

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in madated reporting certificate expires, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/22/2024
Plan of Correction
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Per Licensee she, her daughter and her spouse will complete training and will submit to LPA.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in CPR/1st Aid expired 9/2023, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/12/2024
Plan of Correction
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Licensee and her daughter will be attending training for CPR/1st Aid ESMA approved and will submit a copy of the cards to the LPA.
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:Ana Chico
LICENSING EVALUATOR NAME:Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 07/17/2024 11:30 AM - It Cannot Be Edited


Created By: Carolyn Tuba On 07/15/2024 at 03:28 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020811

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 15 minute sleep log was not available, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2024
Plan of Correction
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Licensee will begin documenting sleep log for the children under 24 months and send a copy to LPA for verification.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Ana Chico
LICENSING EVALUATOR NAME:Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024


LIC809 (FAS) - (06/04)
Page: 3 of 6
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020811
VISIT DATE: 07/15/2024
NARRATIVE
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In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunization's (TDAP, MMR, TB, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.

Detergents, cleaning compounds, medications, and other items, which could pose a danger, were determined to be inaccessible to children in care during this inspection. Medication and knives are kept in kitchen cabinets out of the reach of children. Cleaning supplies are kept in the hallway in a cabinet that is locked with a child proof lock.

LPA observed the required 2:A-10:B-C fire extinguisher and per Licensee it was last serviced on November 10, 2023. State Fire Marshall standards, state that fire extinguisher shall be service annually. The combo smoke and carbon monoxide detectors were tested and are working properly. Currently the facility has 2 small Malti-poo dogs and are kept in one of the bedrooms off limit from the children. Vaccinations are current.

Safe sleep was discussed, and LPA provided safe sleep documentation and PIN 20-24 CCP Safe Sleep. Licensee currently has two children under the age of 24 months. Licensee stated that she supervises the children while napping but is not documenting the 15-minute sleep log for the children under 24 months. LPA provided a sample for her reference. LPA provided Licensee with an Individualized Infant Safe Sleep for children under 12 months for future reference.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR, which includes the EMSA Sticker, however the Pediatric First Aid and CPR expired on 9/2023. Per Licensee she will be scheduling an appointment to renew. There are first aid supplies available. Licensee, her spouse and her assistant have not retaken the mandated reporting training AB 1207. LPA advised that all persons working with children require the Mandated Reporting training every 2 years. The following link http://www.mandatedreporterca.com/ was provided.

Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be enclosed with a concrete wall and iron gate. Per the licensee she supervises the children when they are in the back yard. LPA had the licensee fill out a Declaration for the overall safety of the children due to the environment that there home is near a mountainous area and certain equipment.


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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC809 (FAS) - (06/04)
Page: 4 of 6
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020811
VISIT DATE: 07/15/2024
NARRATIVE
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Children and Staff files must be maintained and updated as needed and must be available for review by the Department. If Children and Staff leave the day care all records must be maintained for 3 years after leaving. LPA observed that children’s files had the following documents of the LIC 700, LIC 627 and LIC 995A available, as well as the immunizations.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/. There are no children currently taking medication.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC809 (FAS) - (06/04)
Page: 5 of 6
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020811
VISIT DATE: 07/15/2024
NARRATIVE
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Licensees was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Please see LIC809-D pages for deficiencies cited during today's visit in accordance with the California Code of Regulations Title 22, Division 12, Chapter 1

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted, and report was reviewed with the Licensee, Evelia Gonzalez.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC809 (FAS) - (06/04)
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