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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005606
Report Date: 03/30/2022
Date Signed: 03/30/2022 03:05:14 PM

Document Has Been Signed on 03/30/2022 03:05 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:GONZALEZ, ELIZABETHFACILITY NUMBER:
214005606
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/30/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Elizabeth GonzalezTIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPA) Haydee Caliboso met with Elizabeth Gonzalez for a change of location pre-licensing inspection of the home on 3/30/22. The applicant and the adult living in the home have been fingerprinted and all cleared. The applicant owns the home, which is a two-level home with 4 bedrooms and 3 bathrooms. The applicant lives with the husband and a toddler child. The hours of operation are Monday - Friday, 7:30AM to 6:30PM. The facility will provide care for children between birth to 5 years old. During the inspection, capacity and ratio requirements were discussed and reviewed with the applicant. There is proper lighting and ventilation in the home, a working telephone, fully functioning smoke and carbon monoxide detectors, and a fully charged 2A10BC fire extinguisher. Applicant’s home is clean, orderly, and equipped with age-appropriate materials and books available for children. LPA observed there are no baby walkers, bouncers, or exersaucers in the home.

Childcare will be provided in the following areas: living room, dining room, kitchen area, family room, hallway bathroom, hallway bedroom, backyard playground, and 2nd floor bedroom#1. 2nd floor bedroom #1 will be used only for nap area by provider’s child/ren only. LPA reminded the licensee that active supervision must be observed at all times when children are present. The hallway bedroom will be used for napping children. Family room will be used as isolation area for ill children. First Aid kit supplies are available and stored in a locked cabinet. The backyard of the home is gated and fenced off.
Cont. 809-C pg. 2
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GONZALEZ, ELIZABETH
FACILITY NUMBER: 214005606
VISIT DATE: 03/30/2022
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Off limit areas: 2nd level of the home; including bedrooms #2 and #3, 2 bathrooms, laundry room, garage, and storage shed in the backyard. The stairs in the home is gated. All cleaning supplies, detergents, and toxins are stored in a locked cabinet made inaccessible to children. Kitchen knives and sharp tools are stored where they are made inaccessible to children. Applicant will provide meals and snacks for the children. There is no body of water such as a swimming pool, spa, hot tub, or fishpond in the home. The home has a fireplace in the family living room which have been barricaded. There are no weapons or firearms in the home. All areas that are off-limits are made inaccessible to children. LPA’s observed that all cabinets and doors have locks and safety latches. LPA observed bottles of alcohol stored in a cabinet located in the living room that is locked and made inaccessible to children.

The applicant was reminded there are no walkers, exersaucers, jumpers, bouncers or any similar items to be used for children in care and shall be made inaccessible. LPA informed the applicant that emergency drills will be conducted at least once every six months and drills must be properly logged. The applicant's First Aid/CPR certificate expires in 7/2023. LPA discussed facility ratios and capacities with the applicant. LPA discussed Mandated Reporter training available on the CCLD website. In addition to the AB1207 training must be completed every two years by all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. The LPA reviewed and discussed all necessary requirements to administer medical treatment. LPA reviewed and discussed isolation of sick children. Positive redirection will be used for discipline.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.
Cont.. 809-C pg.3
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GONZALEZ, ELIZABETH
FACILITY NUMBER: 214005606
VISIT DATE: 03/30/2022
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LPA discussed the safe sleep regulations with applicant 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 applicant 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA provided LIC 311D for forms and records to keep in FCCH. Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parents Rights Poster. Applicant has completed the www.mandatedreporter.ca.com training and a copy is in the file. LPA discussed the effects of lead exposure with the applicant. Resources and materials were sent through email on 3/30/22.

On 3/30/22 LPA Haydee Caliboso received LIC 9217 and proof of property. LPA emailed FCC self-certification to the applicant on 3/30/22. Applicant will need to complete and sign self-certification and returned a copy to LPA Caliboso. A copy will be kept in the applicant’s file.

Prior to approval of small family childcare: the applicant shall complete and submit verification of the following:

· Posting Requirements have been posted
· Hallway bedroom cleared and set-up for nap area
· Fireplace ledge have been child proofed
· A/C unit have been barricaded and gated
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC809 (FAS) - (06/04)
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