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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610495
Report Date: 06/15/2021
Date Signed: 06/16/2021 04:07:08 PM

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 CAREFACILITY NUMBER:
136610495
ADMINISTRATOR:KIMBERLY GONZALEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 592-5279
CITY:BRAWLEYSTATE: CAZIP CODE:
92227
CAPACITY:14CENSUS: 5DATE:
06/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Kimberly GonzalezTIME COMPLETED:
03:00 PM
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***********this is an electronic copy of a hand written report*************

On June 15, 2021 at 1:26 pm, Licensing Program Analyst (LPA), Gloria Gonzalez conducted an unannounced Annual Required Inspection and
met with the Licensee, Kimberly Gonzalez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Five children and one staff were present in the facility during this inspection. The following areas used for child care are: living room, kitchen, bathroom 1, bedroom 1&2, part of backyard. Off limits areas is upstairs rooms 3&4, bath 2&3 and are made inaccessible through use of a baby gate. The fire extinguisher and smoke detector, and carbon monoxide detector met requirements. Hazardous items were made inaccessible to children during inspection. LPA observed a pool that is made inaccessible to children by a fence around the pool as required and the gate swings away. Toys and material are available. Licensee has a back patio area available for outdoor activities. LPA observed locked storage areas for firearms and ammunition. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances. Licensee's first aid and CPR certification expire on 1/2023. Licensee has required immunization's. Licensee completed Mandated Reporter Training on 3/7/21. Facility roster is maintained and was reviewed. The last fire disaster drills were conducted and documented on 6/2021. LPA Provided and discussed the following: Report suspected child abuse and neglect, maintain children's records according to regulation, post all required forms, and ensure that all adults residing or working in the home
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria GonzalezTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021
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: 06/15/2021
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have criminal background clearances. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided information regarding Safe Sleep regulation Section 102425, SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov. In addition, for general questions or questions regarding licensing requirement contact the Child Care Licensing Duty Line at (619) 767-2248. Incidental Medical (IMS) policy was discussed. Licensee states IMS services are not being provided at this time. 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. No Deficiencies cited. An exit interview was conducted with the licensee. The Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. LPA provided Notice of site visit.

Please see original signature on file.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria GonzalezTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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