136610495-2-2-2021-20-CC-MHOD-BXUQWZ-20210202113242

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 136610495
Report Date: 02/02/2021
Date Signed: 02/02/2021 11:33:09 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	GONZALEZ, KIMBERLY FAMILY CHILD CARE		FACILITY NUMBER:	136610495
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	02/02/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Kimberly Gonzalez, Licensee		TIME COMPLETED:	11:40 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 02/02/2021 at 10:25 a.m., Licensing Program Analysts (LPAs), Michelle Hood and Gloria Gonzalez conducted an unannounced Case Management inspection. Upon arrival, LPAs met with licensee, Kimberly Gonzalez and proceeded to tour the inside and outside of the home. During the inspection there were two (2) children in care. Facility operates Monday through Friday; 6:00 a.m. to 6:00 p.m. The purpose of today’s inspection is to inspect the pool fencing to determine if the pool fencing meets CCL title 22 regulations. In addition, the licensee is requesting to add a bedroom #1 and bathroom #2, located on the first story of home as an area that will be utilized for the daycare. LPAs obtained an updated indoor facility sketch at time of inspection. LPAs inspected the backyard pool fencing, bedroom #1 and bathroom #2. The backyard is physically separated between two areas. The pool is located in the corner end of the west side of the backyard. The pool entrance is located near the grassy area of the backyard. LPAs observed the pool gate to be self-closing, self-latching, swings away from the pool and the latch devise placed no lower than 60 inches above the ground. LPA observed the front pool fencing to be 5 feet high with openings on the fence no wider than four inches. The building and fencing on the west side of the pool belongs to the neighbors and there is no egress from the building nor the fencing. In addition, there is no egress from the two sides of the pool fence backyard and the patio area located near the east end of the backyard. The entrance to and from the garage/shed is located on the north side of the backyard and there's no entry into pool area. The garage/shed will be locked during daycare operation. The front pool fencing separating the other areas of the back yard in no way obstructs a complete and clear view of the pool from the outside of the fence. Bedroom #1 has a window that overlooks the pool: however, there is not access to the pool area. During the inspection, LPAs took pictures of the pool fencing and gate. LPAs discussed and reminded Licensee she is responsible for the health and safety of all the children in her care.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Michelle Hood	TELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GONZALEZ, KIMBERLY FAMILY CHILD CARE	FACILITY NUMBER: 136610495
	VISIT DATE: 02/02/2021

NARRATIVE

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The pool fencing, backyard. bathroom #2 and bedroom #1 meet title 22, division 12, chapter 3 regulations.

The following areas used for childcare include the following: kitchen, dining room, living room, bedroom #1, bathroom #1 and bathroom #2 located on first story of home and backyard.

No deficiencies issued throughout today's inspection. An exit interview was conducted with the licensee. LPAs informed licensee Notice of Site visit shall be posted for 30 days from today’s date.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Michelle Hood	TELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021

LIC809 (FAS) - (06/04)

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