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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846206
Report Date: 03/22/2024
Date Signed: 03/22/2024 01:24:10 PM

Document Has Been Signed on 03/22/2024 01:24 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
334846206
ADMINISTRATOR:GONZALEZ, SUSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 333-5606
CITY:EASTVALESTATE: CAZIP CODE:
91752
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
03/22/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Licensee Susana GonzalezTIME COMPLETED:
01:35 PM
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On 03/22/2024 at 8:45 AM Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct an Case Management inspection to follow-up on Plans of Corrections. In addition, The license is requesting approval open the Garage for drop off only, to allow authorized representatives access by using the Garage door attached to the kitchen when entering the facility. LPA was greeted by Licensee Susana Gonzalez and granted entry to tour the facility inside and out. LPA reviewed records and observed and/or discussed the following: The licensee and 3 adults present at the home. LPA took a census of 9 children in care.

Normal days and hours of operation are Monday- Friday, 5:30 AM to 6:00 PM, Weekends upon request.
OFF-LIMIT AREAS INCLUDE: The entire 2nd Fl; Garage will remain off limits until verification of corrections is received to open the garage for as a drop off location only.

LPA conducted a review children and staff records for the plan of corrections. A review of children's records show that the licensee is NOT operating within the terms of the license, due to having 5 children under the age of 24 months, present and in care.

Plan of Corrections reviewed and discussed from 01/18/2024 inspection:
1. HSC 1597.543 Licensing Requirements: LPA observed and verified the licensee purchased a new carbon monoxide detector located in the kitchen area, next to the sink.
2. CCR 102417(g)(3) Operation of a Family Child Care Home: -LPA verified the gate is mounted preventing accessibility for children to climb the stairs.
3. CCR 102417(g)(7) Operation of a Family Child Care Home: LPA reviewed children's records and verified LIC700 & LIC627 on file for all children present.
4. CCR 102418 Child Records - LPA verified immunization records on file for subject children
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 334846206
VISIT DATE: 03/22/2024
NARRATIVE
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Plans of Corrections continued:
5. HSC 1597.622(a)(1) Immunization - LPA Verified required health screenings for TB, immunization and vaccination records, are on file for staff present and working with children.
6. 102425(j)(2)(D)(c) Infant Safe Sleep/ 15 Minute Sleep logs, pending written statement of understanding.
7. 102425(b) Infant Safe Sleep / Cribs or play yards shall be free from all loose articles and objects: Pending written statement of understanding.

LPA S. Brewer verified that a signed Acknowledgement of Receipt of Licensing Report dated 01/18/2024, LIC 9224 forms, are placed in the child's file and reminded the licensee that the LIC9224, is required for any new enrolled children.

A deficiency was cited for Type B violation on today's date.

No Civil Penalties were issued.

A Notice of Site visit was given and must remain posted for 30 days. LPA verified the notice was posted prior to exiting the facility.

Exit interview was conducted and the report was reviewed with the licensee Susana Gonzalez, and a copy left.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/22/2024 01:24 PM - It Cannot Be Edited


Created By: Susan Brewer On 03/22/2024 at 12:26 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 334846206

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/25/2024
Section Cited
CCR
102416.5(d)(1)

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Staffing Ratio/Capacity(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time...(1) Twelve children, no more than four of whom may be infants... The regulation was not met as evidenced by:
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The licensee agrees operate within the terms of their license by ensuring the maximum number of children who care may be provided at any one time, is 12 children, no more than 4 of whom may be infants or, No more than 3 infants are cared for during any time when more than 12 children are being cared for.
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Based on LPA observation, interview and record review, the facility exceeded the terms of the license with 5 infant/toddler children under 24 months of age present and in care, which is a potential risk to the health and safety of children in care.
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The licensee agrees to submit a statement of understanding the regulation 102416.5(d)(1) and submit a plan for managing the care and supervision of children enrolled at the daycare that ensures the licensee will not exceed the requirements for ratio & capacity, by fax, mail or e-mail.

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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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2024


LIC809 (FAS) - (06/04)
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