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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011999
Report Date: 05/11/2023
Date Signed: 05/11/2023 10:28:19 AM


Document Has Been Signed on 05/11/2023 10:28 AM - 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
198011999
ADMINISTRATOR:GONZALEZ, YOLANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 969-7579
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY:14CENSUS: 4DATE:
05/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Yolanda Gonzalez TIME COMPLETED:
10:45 AM
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Licensing Program Analyst's (LPA) Judy Mora and Mary Silva conducted an unannounced annual required inspection at the above facility on 05/11/23 at 8:30 AM. Licensing staff met with Yolanda Gonzalez, Licensee who guided licensing staff on a tour of the facility. 4 children were present during this visit. Per Licensee, there are 14 children currently enrolled. During this visit there was 4 adults in the home, licensee, assistant Maria Gonzalez, daughter Leslie Velasquez and son Sergio Gonzalez..

Family members residing in the home have criminal record clearances on file and 3 children also reside in the home. This is a one story home which consists of 4 bedrooms, 2 bathroom, kitchen, laundry room, living room, dinning room, den/play room, garage, front yard, and backyard. The children do not have access to the front yard, garage, kitchen, 4 bedrooms and 1 bathroom.

Licensing staff observed a fireplace in the den/playroom, covered by a board making it inaccessible to the children in care.

There is central air and heating. Per license there is a landline in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicates fully charged, based on receipt purchased on 02/03/23.

Currently children use backyard for outdoor play. The outdoor play area was observed to be fenced. Licensing staff observed that the outdoor yard has toys and other materials for children to play with. Licensing staff observed a exersaucer exiting the playroom in the outdoor area to the right side. Licensee removed item to be disposed. LPA did not observe any objects that could be hazardous to children in care.

LPA observed the following required posted documentation: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form. LPA reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan. The last disaster drill has been completed 04/01/2023.


REPORT CONTINUES ON NEXT PAGE
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5


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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198011999
VISIT DATE: 05/11/2023
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LPA observed the following required posted documentation: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form. LPA reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan. The last disaster drill has been completed 04/01/2023.

Licensee states that there are no poisons stored in the home and understands that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up will be in the living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home. Per licensee transports school age children.



Infant Care: The facility is currently caring for infants under 12 months. 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. A technical violation was given on this day, licensee will begin 15 minute documentation when infant is in care.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). Children's records were observed to be complete.



Licensee's records were reviewed for approved Pediatric First Aid and CPR certification, the Licensee's and assistant's certification expires on 10/23. Licensing staff reviewed the LIC 508- Criminal Record Statement, Proof of immunization's against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse.

AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com. The Licensee's AB1207 certification expires on 03/24 and assistant's certification expired on 04/23. A technical violation was given on this day.
*REPORT CONTINUES ON NEXT PAGE
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198011999
VISIT DATE: 05/11/2023
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Incidental Medical Services (IMS) policy was discussed. Per licensee no children in care are receiving IMS services. 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.

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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee, Yolanda Gonzalez.

*END OF REPORT

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5