198018894-2-5-2020-33-CC-JANO-BLJ3EF-20200205171105

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198018894
Report Date: 02/05/2020
Date Signed: 02/05/2020 05:11:23 PM

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:	GODOY FAMILY CHILD CARE		FACILITY NUMBER:	198018894
ADMINISTRATOR:	MAYRA SAHARA GODOY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 671-4019
CITY:	POMONA	STATE: CA	ZIP CODE:	91766
CAPACITY:	14	CENSUS: 6	DATE:	02/05/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Mayra Godoy		TIME COMPLETED:	05:00 PM

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	Licensing Program Analysts (LPAs) Emiko Bell and Jennifer Anguiano conducted an unannounced annual random inspection to the above facility. LPA met with Staff #2 at the time of arrival and stated Staff #1 was not present. Licensee Staff #1 arrived to the facility at 2:30pm. Licensee who guided analysts on a tour of the facility at 2:35pm. Also present during this inspection, was Staff#2, Licensee’s Assistant. Per Licensee, there are 8 children that are currently enrolled. A current children’s roster was available for review. There were 6 children present upon arrival. Hours of operation are M-F 7:30am-5pm. LPAs reviewed parent board in the facility to determine if all posting requirements were available for view. All postings were observed. Staff-child ratio was met. This is a one-story home which consists of 4 bedrooms, 1 bathroom, kitchen, dining room, living room, front yard and backyard (fenced). The 4 bedrooms and bathroom, kitchen, dining room, front yard are off limits. Children and staff occupy back yellow room and blue room along with small kitchen and restroom with changing table accessible. Staff #1 and Staff#1 spouse, Staff#2 were present during the inspection. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms or weapons on the premises. PAGE - 1 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer Anguiano	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GODOY FAMILY CHILD CARE	FACILITY NUMBER: 198018894
	VISIT DATE: 02/05/2020

NARRATIVE

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Children’s records were reviewed and observed to be complete.

Staff files records were reviewed and observed to be complete.

LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection.

Fire drill log was provided and documented on 1/13/20 at 10am.
There are pets on the premises and are not accessible to children in care during operating hours.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License was in blue room were observed to be posted.

LPA did the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family childcare facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

LPA advised the licensee to sleep infants where they can always be directly supervised and advised the licensee against sleeping infants in a separate room. LPAs observed infant sleep on a mat in blue room on her back. All children sleeping in blue room were supervised during LPAs visit.

LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA also consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, and Safe Sleeping practices.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer Anguiano	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GODOY FAMILY CHILD CARE	FACILITY NUMBER: 198018894
	VISIT DATE: 02/05/2020

NARRATIVE

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LPA provided licensee with the LEAD facts flyer for their records.

LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Mayra Godoy an copy of this report was signed and provided to Licensee Mayra Godoy.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer Anguiano	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

LIC809 (FAS) - (06/04)

Page: 4 of 4

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: GODOY FAMILY CHILD CARE	FACILITY NUMBER: 198018894
	VISIT DATE: 02/05/2020

NARRATIVE

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All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a landline that is used during operation hours. There is ventilation and heating (central). The following was observed and reviewed during this inspection

PHYSICAL PLANT
Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary with all cleaning compounds stored up high away from children.

The valve on the required 2-A:10-B:C fire extinguisher indicates fully charged and was serviced on February 19, 2019 as indicated on service tag. Smoke and carbon monoxide detectors were tested by license and are operable.

The home is observed to be clean and orderly. There is a child safety gate which keeps stairs inaccessible to children. There are toys available for children. Appropriate sleeping arrangements and mats were available.

Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced and shaded. LPA observed that the outdoor yard has toys and other materials suitable for children. LPA did not observe any objects that can pose a danger to children on the outdoor yard.

The licensee is observed to be operating within the license capacity limitations.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid Staff#1 exp. 7/2020, Staff#2 exp.10/2020. First aid supplies are available.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer Anguiano	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

LIC809 (FAS) - (06/04)

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