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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011849
Report Date: 09/21/2022
Date Signed: 09/21/2022 01:35:29 PM


Document Has Been Signed on 09/21/2022 01:35 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
198011849
ADMINISTRATOR:GONZALEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 232-4043
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY:14CENSUS: 6DATE:
09/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Maria Gonzalez, LicenseeTIME COMPLETED:
01:55 PM
NARRATIVE
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On 09/21/22, Licensing Program Analysts (LPA) Susann Sanchez conducted unannounced annual inspection. LPA met with Maria Gonzalez, Licensee who guided analysts on a tour of the facility. There were 6 children present with the Licensee when LPA arrived. Facility capacity is in compliance for a Large Family Child Care Home. Per Licensee, hours of operation are Monday through Sunday, 12:00 am to 11:58 pm. Licensee states that she will care for children Infants -12 years of age.

The home is a one story, 3-Bed, 2-Bath home. There is a dwelling in the backyard. Per Licensee dwelling is the same address and no one lives in the back. The following areas are used for day-care: 2 bedrooms, bathroom next to the kitchen, living Room (as a walk way to the kitchen), dining room, and backyard area. Off limit areas include: Licensee’s bedroom & bathroom, dwelling, laundry area in the and front yard. LPA also inspected the bathroom near the kitchen and is free of hazards.

All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home.



All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. The following was observed and reviewed during this inspection.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 9/2/22.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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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Document Has Been Signed on 09/21/2022 01:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198011849

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. During inspection LPA observe and photographed the fire extingusiher and it was empty, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/05/2022
Plan of Correction
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Per Licensee will purchase a new 2A10BC fire extingushier and send LPA a photo via email at susann.sanchez@dss.ca.gov by POC due date of 10/05/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198011849
VISIT DATE: 09/21/2022
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 Around 10:55am LPA observed the 2A10BC fire extinguisher was shows that it is empty. Licensee has two other fire extinguisher but they are not the required 2A10BC, they are smaller.

Smoke and carbon monoxide detectors were tested and are operable. The home maintains telephone service via landline and cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that detergents, cleaning compounds and medication are under the locked kitchen cabinets and was inaccessible to children. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in bedroom, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

Infant Care: Currently licensee has 0 infants enroll. LPA observed 1 playpen and 1 crib. LPA reviewed the following in case Licensee has infants in the future: napping equipment can not block entrances or exits. Infant mattresses were need to be firm with tightly fitted sheets. Playpens or cribs can not have any loose object, bumpers, objects hanging, or objects attached. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP. LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Currently, children are using the back yard for outdoor play. LPA's observed that the outdoor yard has toys and other materials for children to play with. LPA's did not observe any objects that could be hazardous to children in care. Licensee stated that the children are always supervised when they are outside. Per Licensee there are no bodies of water on the premises.



Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunizations Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form was given during inspection and the sleep log (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months).
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198011849
VISIT DATE: 09/21/2022
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Staff records were reviewed for approved Pediatric First Aid and CPR certification, which expires on 11/16/2023. LPA observed the following at the regional office: LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza, TB clearance or risk assessment, LIC 9108- Statement of Child Abuse, but Licensee could did not have copy upon request. LPA issues a technical violation. LPA explain to Licensee that she needs to obtain the AB1207 Mandated Reporter Training Certificate. Licensee was unaware of the training and has not had a visit since 2018.

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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that 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.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.


SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198011849
VISIT DATE: 09/21/2022
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LPA observed birds in cages in the backyard.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were given and explained. Exit interview conducted and report was reviewed with the Licensee, Gonzalez.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
LIC809 (FAS) - (06/04)
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