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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700328
Report Date: 08/05/2021
Date Signed: 08/05/2021 04:03:48 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
197700328
ADMINISTRATOR:GONZALEZ, PRISCILLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 317-9720
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:14CENSUS: 4DATE:
08/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:06 PM
MET WITH:Brianna Rodriguez and Priscilla GonzalezTIME COMPLETED:
04:15 PM
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On 8/5/2021, Licensing Program Analyst (LPA) Carol Heath met with the assistant Brianna Rodriguez and Lianna Carillo who granted access into the home. The licensee, Priscilla Gonzalez was not home. The purpose of the inspection is to conduct an unannounced Required 1 Year inspection at the above facility. Licensee is licensed to provide care and supervision for a large family child care for the capacity of 14 children. During the time of this inspection, the licensee had 5 children in care: 2 toddlers and 3 school age. There are only 15 child enroll this facility.

Currently residing in the home are the licensee, her spouse, her daughter (9 years). LPA toured the home inside and out Per LIS, facility annual fees are current. This facility operates from 7:00 Am to 6:00 PM Monday- Friday Incidental Medical Services (IMS) policy was discussed.

The home is set up as follows:

This is a two story home with 4 bedrooms, 3 bathrooms with kitchen, living room, dining room, family room, laundry room and attached garage.

Main care is proved in the playroom (Family room), living room, dining room and Bedroom #1 (Napping room). LPA observed age appropriate furniture, materials and books in the room. In the living, there are several school ages tables and a couch for older children. Dining room has a big wood table for children to eat their snacks or meals. LPA observed napping equipment (2 Play yard cribs) in the Bedroom #1. Children use the Bathroom located next to bedroom #1.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700328
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/05/2021
Section Cited

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Criminal Record Clearance:
102370(d)(1) Criminal Record Clearance. All
individuals subject to a criminal record review
as specified in Section 1596.871 prior to
working...btain a California clearance or a
criminal record exemption as required by the
Department.
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This requirement is not met as evidence by:
Based on observation and interviews, the
licensee did not ensure a criminal reocrd
clearance was for her assistant Lianna Carrilio, which poses an immediated Health, Safety or
Personal Rights risk to persons in care.
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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: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700328
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2021
Section Cited

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1596.8662(b)(2):On and after January 1, 2018, a person who applies for a license to be a provider of a child day care facility ... shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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This requirement is not met as evidence by:
Based on observation and interviews, the
licensee did not complete mandated reporter training. which poses an immediated Health, Safety or Personal Rights risk to persons in care.
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Type B
08/13/2021
Section Cited

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102416(c): The licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidence by
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Based on observation, record review and interviews, the licensee and her assistant's CPR and First Aid have been expired.
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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: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700328
VISIT DATE: 08/05/2021
NARRATIVE
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Off limit areas include second floor (Bedroom #2, #3 and #4), Bathroom #2 and the bathroom located in the master bedroom. The home is clean, orderly, comfortable, and well ventilated. Licensee's poisons, detergents, cleaning compounds, medications, and other items which could pose a danger to children are stored under the sink with locks. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating (central) and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Kitchen (Off-Limit area): The kitchen was inspected to ensure hazardous items were inaccessible to children. All cabinets in the kitchen were inspected and are free of dangerous items. The licensee keeps knives and other sharp objects such as (scissors) on an upper cabinet shelf. All cleaning compounds/detergents are stored in the garage so that they are inaccessible to children.

Backyard: The backyard is fenced. The backyard was inspected, the backyard is grass landscaping surrounded by brick. LPAs observed 1 storage shed on the left side of the home that was enclosed by a chain linked gate. The AC/Heating Unit was enclosed in the chain linked gate which make the unit is inaccessible to children. There was a pool observed in the backyard area. LPA inspected fencing around the pool. The wrought iron fencing is at least five feet high. The fence is constructed so that it does not obscure the pool from view. The wrought iron gate swings away from the pool. The pool has a self-closing latch located no more than four inches from the top of the gate. The gate was able to close by itself with no assistance. Pool can be observed through the glass window in the kitchen and a window located in the family room playroom area.

There is a fireplace located in the living room which is properly screened and meets all safety requirements. The Licensee put several school ages tables in front the fireplace. Per licensee, there are no weapons or firearms on the premises. LPA observed there is a required fire extinguisher on (3A40BC). According to Licensee, she had it refill last year. The Fire extinguisher is located outside the Playroom. The smoke detectors and carbon monoxide devices tested operable. LPA did not observed the First Aid Kit.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700328
VISIT DATE: 08/05/2021
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The Licensee is not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed with the Licensee. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm


· LPA observe licensee has current Pediatric CPR and First Aid Training expired 05/07/2019 and for Brianna Rodriguez expired 1/20/2021, 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.
· The licensee has the required immunization. The licensee provided a written statement declining the influenza vaccination.
· The licensee did not renewal and complete the online mandated reporter training at www.mandatedreporterca.com. Her assistants will need to take the online mandated reporter training also.
· Licensee will provide transportation for children if the family is needed.
· LPA reviewed 9 child the records are complete.
· Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on Last month.
· LPA observed the Facility Roster. Per Licensing Information System, facility annual fees is current.
· Licensee has posted as required the Facility License, Emergency Disaster plan, and Parents Rights Poster. The facility roster is not current. there are no current facility earthquake/fire drills documents observed during the time of this inspection.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700328
VISIT DATE: 08/05/2021
NARRATIVE
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The following information was discussed with the licensee:
ü Mandatory Forms for the children’s files and provider’s files.
ü Requirements for fire drills, earthquake drills, and documentation for both.
ü The role and responsibilities of being a mandated reporter were discussed.
ü The licensee is reminded that 100% supervision is required for children at all
times.
ü Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
ü Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.
ü Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
ü The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
ü The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507
ü The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700328
VISIT DATE: 08/05/2021
NARRATIVE
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ü --Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
n Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
ü The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.
ü A copy of the Safe Sleep Proposed Regulations was provided to Licensee.
ü LPA provided consultation during the inspection.

The following Type A and Type B deficiencies were cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.


Exit interview conducted with Licensee. A copy of this report is discussed and left with the licensee.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
LIC809 (FAS) - (06/04)
Page: 7 of 7