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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300634
Report Date: 12/20/2022
Date Signed: 12/20/2022 11:22:54 AM

Document Has Been Signed on 12/20/2022 11:22 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:VALLEJO-GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
376300634
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/20/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Blanca Vallejo-GonzalezTIME COMPLETED:
11:30 AM
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On December 20, 2022 at 9:54 AM, Licensing Program Analysts (LPAs) Cindy Hamilton and Lorena Valenzuela arrived at the facility to conduct a pre-licensing inspection. Present during this inspection were: Blanca Vallejo-Gonzalez, applicant, Laura Rivera, mother-in-law, Adriana Fierro, daughter and Blanca Gonzalez, mother. The home is two-story with 5 bedrooms, 3 bathrooms, with attached garage. LPA Valenzuela toured the facility, inside and out with Blanca Vallejo-Gonzalez and the following was observed and/or discussed:

· Per Applicant, off-limit areas include: garage, downstairs bedroom, upstairs bedrooms and bathrooms and downstairs pantry. Off-limit areas have door locks and gates making them inaccessible to children.
· Normal hours of operation will be: Monday – Friday, 7:00 am to 5:00 pm
· Smoke detectors and Carbon Monoxide detectors were tested by the applicant during this inspection and were in working order.
· There is central heating and air conditioning.
· The fire distinguisher is a 3-A:40-B:C, fully charged and met standards established by the State Fire Marshal.
· All hazardous items were observed to be inaccessible. Storage of poisons and toxins are inaccessible to children and locked in cabinet in the kitchen. Sharp items including kitchen knives, are inaccessible and stored in upper cabinets in kitchen. Medicines are locked and stored in upstairs bathroom and upper kitchen cabinet closest to the garage.
· First Aid Kit is located in the cabinet in flex room/day care area, and contains all required items.
· Guns or weapons are stored in the facility as of this date. Applicant understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations. Gun is stored in a locked closet in applicants bedroom that also has a lock on bedroom door.
· Stairs are barricaded.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2022
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: VALLEJO-GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 376300634
VISIT DATE: 12/20/2022
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· Clean, safe and age-appropriate toys were observed.
· LPA observed a working mobile telephone.
· There were no toxic plants inside or outside the facility observed at this time
· The outside activity area is pending due to HOA approval for concrete. Applicant will advise LPA once area is ready for use. LPA Valenzuela did observe toys and equipment for outdoor area.
· There are no bodies of water observed on this date. Applicant understands all bodies of water including ponds, above ground pools and spas, in-ground pools and spas, and some fountains must be properly covered or fenced per title 22 regulations. The Department must be notified before and after installation of the bodies of water described. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.
· Verification of control of property is maintained by applicant
· Facility Sketch and Emergency Disaster Plan are posted in flex room/daycare area.
· Pediatric CPR and First Aid Card expires March 2023
· Mandated Reporter certificate expires June 2024 and December 2024
· Preventive Health and Safety training, including nutrition and lead components have been completed by Blanca Vallejo-Gonzalez.
· The applicant, Blanca Vallejo-Gonzalez, confirmed there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

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

LPAs were advised during the inspection that applicants mother Blanca Gonzalez recently came to stay with applicant and does not have a background clearance. Applicant was reminded 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. Applicant stated will have mother fingerprinted today and will submit required documentation to the Department as soon as possible. Applicant advised home can not be licensed until all adults have been cleared.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: VALLEJO-GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 376300634
VISIT DATE: 12/20/2022
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LPA discussed the safe sleep regulations with applicant Blanca Vallejo-Gonzalez 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, licensee, or facility representative] 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.

LPA reviewed with Blanca Vallejo-Gonzalez the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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.

The following items were also reviewed with the applicant during inspection:
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months
- Responsibilities of being a mandated reporter and updating training every 2 years
- Personal rights of children in care, including no corporal punishment
- Responsibility to know the Title 22 Regulations for anyone providing care and supervision
- Capacity and Supervision requirements
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility phone numbers must always be on file with the licensing office
- Baby walkers, bouncy seats, exert-saucers and other similar items are prohibited
- Car seat law
- Smoking is prohibited in the facility while providing child care or transporting children
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: VALLEJO-GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 376300634
VISIT DATE: 12/20/2022
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- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of
30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also
be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
- Applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
-The Applicant can submit fingerprint transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov
- Access to forms & Title 22 Regulations for Family Child Care Homes online at www.ccld.ca.gov
- The Duty Officer is available to answer questions Monday – Friday 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.


Before licensure, the following needs to be corrected/completed:
1. Mother Blanca Gonzalez fingerprinted and background clearance and TB tested.
2. Facility sketch of second floor.
3. Postings: child passenger safety law, emergency drills log, complaint hotline, earthquake preparedness checklist.

Once all corrections have been verified, the application for a Small Family Child Care Home will be submitted for approval with a maximum capacity of 6, or 8 with parent notification. Applicant advised that all corrections are due within 30 days (January 23, 2023) or the application may be withdrawn.

Exit interview conducted and report was reviewed with the applicant Blanca Vallejo-Gonzalez.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC809 (FAS) - (06/04)
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