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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415959
Report Date: 04/13/2023
Date Signed: 04/13/2023 02:50:45 PM

Document Has Been Signed on 04/13/2023 02:50 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GONZALEZ ANAYA, ARACELIFACILITY NUMBER:
274415959
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
04/13/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Michelle Gonzalez AnayaTIME COMPLETED:
03:00 PM
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On 04/13/2023 at 1:50 PM, Licensing Program Analyst (LPA) Susy Cervantes met with licensee's adult daughter, Michelle Gonzalez Anaya, for a case management visit to increase the capacity. Daughter stated their mom stepped out and would return shortly. Present during today's visit were the daughter/assistant, licensee's parents, aunt, husband and her children with 1 preschool child. Shortly after LPA's arrival, licensee arrived. Adults living in the home are licensee, their spouse, licensee's parents and their daughter with four children ages 12, 9, 5 and 2. Days and hours of operation are Monday through Friday 5:00 AM to 5:00 PM.

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 04/12/2023 was reviewed and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. 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.

LPA inspected inside and outside of the home. An annual inspection had been conducted on 12/28/2022 and there were no deficiencies. LPA observed a fire pull station by the front door. LPA observed a 2A10BC fire extinguisher that was serviced on 03/01/23. Carbon Monoxide detector and smoke detectors were operable. LPA observed licensee and assistant/daughter have CPR and First aid that expires on 09/2024 and 03/2025. LPA reviewed with licensee FCCH large capacity/ratio requirements and children's documents.

Exit interview conducted and report was reviewed in Spanish with the licensee, Araceli Gonzalez Anaya. LPA advised licensee that licensure for a large Family Child Care Home license is approved pending the following:



- Management's approval
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
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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