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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215443
Report Date: 04/16/2021
Date Signed: 04/16/2021 12:30:01 PM

Document Has Been Signed on 04/16/2021 12:30 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GONZALES FAMILY CHILD CAREFACILITY NUMBER:
566215443
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
04/16/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Elvira GonzalesTIME COMPLETED:
12:29 PM
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On 4/16/2021, Licensing Program Analyst (LPA) Austin Rios met with Licensee Elvira Gonzales and explained the purpose of the visit. Due to COVID-19, a tele-inspection of the facility was completed for an Increase of Capacity inspection. Together the LPA and applicant toured the home inside and outside.

The home is a single-story home with three bedrooms and two bathrooms. Licensee uses the living room, dining room, hall bathroom, and back yard, for day-care. All bedrooms, one bathroom, and garage are inaccessible to the children. There were two children in care at the time of inspection. Fire-Clearance was granted on 4/9/2021. The 2A10BC regulation fire extinguisher was purchased on 3/21/2021. LPA observed functioning smoke and carbon monoxide detectors in the home. Toxins and hazards are inaccessible to the children. LPA observed two gates on both entrances into the kitchen and locks on the bedroom doors making them inaccessible to children in care. There are age appropriate toys and day-care equipment in the home. The fenced back yard has age appropriate toys and day-care equipment. LPA advised applicant must provide visual supervision while the children are playing both inside the home and outside in the backyard. Licensee stated that there are no firearms or ammunition in the facility. LPA did not observe any bodies of water in the home. First Aid/CPR certificates is valid until 5/11/2021. AB 1207 Mandated Reporter Training Certificate expires 1/29/2023.

LPA discussed and verified SB 792 (Child Care Employee and Volunteer: Immunization and Tuberculosis Requirements). Applicant was informed walkers, bouncers and any similar object that restricts children's movement are prohibited from licensed facilities.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2021
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GONZALES FAMILY CHILD CARE
FACILITY NUMBER: 566215443
VISIT DATE: 04/16/2021
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LPA Rios reviewed COVID-19 guidelines/resources with Licensee LPA also reminded Licensee of the new child care regulations for infants and to continue monitoring the CCLD website at ww.ccld.ca.gov for updates.

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

There were no deficiencies cited today. The LIC 9213 (Notice of Site Visit) was emailed to the Licensee.

The facility is licensed for a capacity of 14 children effective today, 4/16/2021.



“Exit interview was conducted with Elvira Gonzales via tele-inspection, during which the report was explained. This report will be sent to Licensee via email with a read receipt or confirmation of receipt of email, which will act as the Licensee's signature.”

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
LIC809 (FAS) - (06/04)
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