198019135-12-18-2023-33-CC-SPEY-CYN3QN-20231218172726

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019135
Report Date: 12/18/2023
Date Signed: 12/18/2023 05:27:50 PM

Document Has Been Signed on 12/18/2023 05:27 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	GONZALEZ FAMILY CHILD CARE		FACILITY NUMBER:	198019135
ADMINISTRATOR:	GONZALEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 974-5772
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90032
CAPACITY:	14	CENSUS: 4	DATE:	12/18/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:56 PM
MET WITH:	Maria Gonzalez, Licensee		TIME COMPLETED:	05:35 PM

NARRATIVE

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Licensing Program Analyst (LPA) Staicy Perry and Licensing Program Manager Claudia Guangorena conducted an unannounced 3 year required inspection at the above facility on 12/18/2023 at 12:56 pm. Licensing staff met with Licensee Maria Gonzalez, who guided staff on a tour of the facility. There were 4 children present upon arrival. The licensee is observed to be operating within the license capacity limitations for a Large Family Child Care Home. A current children’s roster is available and is current. Hours of operation are Mon-Fri 7:00 AM - 6:00 PM.

The licensee provides care in the home. All areas identified on the facility sketch were inspected. This is a two story home which consists of 4 bedrooms, 3 bathrooms, laundry area, kitchen, dining room, living room with a fireplace inaccessible to children with a barricade, family room, garage, backyard (fenced) and front yard. The children will use the family room, bathroom right next to the family room, bedroom #2 and backyard for play (fenced). Areas off limits include bedrooms #1, bedroom #3 and Bedroom #4, Living room, dining room, laundry area, kitchen, and front yard.

Parents and children enter through the front gate and come in through the back door of the house that leads to the family room. Per licensee the children will occasionally enter through the front door of the house in which the children have access to the “off limit” areas. Licensing staff informed licensee to place kiddie gates to make the areas inaccessible to the children as they pass by to go to the family room. As Licensing staff observed knives, medications and cleaning products accessible. Licensing staff observed medication in kitchen and living room area that is accessible to children. Licensing staff informed licensee that medications need to be made inaccessible to children. Medications should be placed in a locked cabinet made inaccessible to children. Licensing staff reminded licensee bedrooms must be made inaccessible to children if they are designated to be off limits.

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

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 11

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019135
	VISIT DATE: 12/18/2023

NARRATIVE

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Currently residing in the home are four adults (licensee, licensees’ son, sons wife and licensee’s husband) and no minors. There was a total of 2 adults present during this inspection, Licensee Maria and Licensee’s Assistant Elizabeth Berganza. Persons living in the home are identified on the attached LIC 811. All individuals present in the home have not obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home. Per licensee, there are no weapons, firearms, or bodies of water on the premises. Licensing staff did not observe through record review fingerprint clearance for licensees son, Ivan Gonzalez.

Licensing staff were led on a tour of the facility by the licensee. Licensing staff observed the following required posted documentation in the main entry way on the door of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPAs reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log. Last drill was conducted on 12/12/2023.

The home was observed to be clean and orderly, with central heating and cooling. Licensing staff observed age-appropriate toys and equipment present for children. Licensing staff observed the smoke detector and Carbon Monoxide detector to be in operable condition. Licensing staff observed a fire extinguisher located in the family room, the valve on the required 2-A-10-B-C fire extinguisher indicates fully charged and was last purchased on 12/13/2023, as indicated on attached receipt with proof of purchase. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Licensing staff discussed the importance of ensuring the fire extinguisher is serviced or a new canister is purchased annually the home maintains telephone service via cell phone that always remains in the home. There are toys and other age-appropriate material available for children. Licensee stated that she provides all the meals for the children. Stairs were not observed to be fenced or barricaded making them accessible to the children.

Licensee states that there are no poisons stored in the home and understands that all poisons must be locked, to be made inaccessible to children. Licensing staff reminded licensee smoking is not allowed in the home. There are first aid supplies available. Licensee stated that family area is used as an isolation area for an ill child until an authorized representative comes to pick up child and all other children will be placed in bedroom #2. LPAs observed napping equipment in the form of mats for the children in care as well as 2 cribs for the infants. Page 2

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC809 (FAS) - (06/04)

Page: 2 of 11

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019135
	VISIT DATE: 12/18/2023

NARRATIVE

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The Licensee uses the back yard for outdoor play. The outdoor play area was observed to be fenced. Licensing staff did observe backyard area to have storage items behind a fence that can potentially fall into the play yard area which can pose a danger to the children in care. Technical Advisory being provided. Licensing staff also observed plants and garden along the outskirts of the play yard. Licensing staff informed licensee to place a gate to separate the garden with the children’s play area. The outdoor yard has toys and other materials for children to play with. Licensing staff observed a play structure with toys and other age-appropriate material available for children.

-There are no pets on the premises.
-Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that falls into these categories are not permitted in a family childcare facility. Licensing staff observed a saucer chair located in the outside play yard.
-Smoking is prohibited in a license family childcare home.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, and LIC 995A Notification of Parents’ Rights. Licensing staff did not observe Immunization's Records for 3 out of the 4 children files reviewed.

Staff and Licensee files were reviewed for the following: LIC 508- Criminal Record Statement, Proof of immunizations against measles, pertussis and influenza or influenza declination, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse. Per licensee, no staff files were available for review at the time of inspection. Licensee was able to provide her TB clearance or risk assessment only. Pediatric First Aid and CPR certification was not available for licensee & Licensee’s assistant. Licensing staff advised licensee First Aid and CPR training must be taken in person with an EMSA approved vendor. Mandated Reporter Training for licensee and Licensee's assistant has not been completed. www.mandatedreporter.ca.com

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC809 (FAS) - (06/04)

Page: 3 of 11

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019135
	VISIT DATE: 12/18/2023

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INFANT CARE: Licensee states that she provides care to infants. Per licensee, currently she has 2 infants enrolled in her daycare. Licensee states that infants sleep in bedroom #2 where they are constantly supervised. Appropriate sleeping arrangements and cribs were not observed. (Two cribs were observed.) Cribs or play yard did not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Licensing staff did not observe firm mattresses. Cribs were observed to be to have loose articles and objects. Licensing staff observed objects to be hanging above cribs and attached bumpers to the side of the crib. LPAs did observe one crib to have a changing table attached to the crib on the top. Licensing staff did not observe any infants swaddled while in care. Licensing staff advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. Licensing staff provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Licensing staff also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

LPA Perry 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC809 (FAS) - (06/04)

Page: 4 of 11

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019135
	VISIT DATE: 12/18/2023

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

MyChildCarePlan.org – Centers and Family Child Care Homes - Licensee Olga Gonzalez, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Megan’s Law - Family Child Care Homes - During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Based on Licensing staff observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

Licensing staff informed licensee Maria Gonzalez that this report dated 12/18/2023 shall be posted for 30 consecutive days as there are immediate risk(s) to the health, safety, or personal rights of children in care.

Licensing staff informed licensee a copy of this licensing report dated 12/18/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC809 (FAS) - (06/04)

Page: 5 of 11

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019135
	VISIT DATE: 12/18/2023

NARRATIVE

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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.

Based on Licensing staff observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

Licensing staff informed licensee a copy of this licensing report dated 12/18/23 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC809 (FAS) - (06/04)

Page: 6 of 11

Document Has Been Signed on 12/18/2023 05:27 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019135
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102417(g)(4)

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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above, Licensing staff did observe medications to be accessible to the children, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/19/2023
	Plan of Correction
1 2 3 4	Licensee will provide LPA Perry with proof that medications will be in a stored locked box making them inaccessible.

Type A

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above, Licensees son, Ivan Gonzalez, is not fingerprint cleared which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/19/2023
	Plan of Correction
1 2 3 4	Licensees son Ivan Gonzalez obtained his fingerprints during today's visit.

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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC809 (FAS) - (06/04)

Page: 7 of 11

Document Has Been Signed on 12/18/2023 05:27 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019135
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(d)(1)

Operation of A Family Child Care Home

(d) The home shall provide safe toys, play equipment and materials. (1) Fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Product Safety Commission shall not be used for children in care or accessible to children in care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations the licensee did not comply with the section cited above, Licensing staff did observe a baby saucer in the back playyard, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/22/2023
	Plan of Correction
1 2 3 4	Licensee will disgard baby Saucer and sign a declaration to LPA Perry by POC date of 12.22.23.

Type B

Section Cited

CCR

102417(g)(3)

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: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations licensee did not comply with the section cited above, stairs leading to the 2nd story are not barricaded which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/15/2024
	Plan of Correction
1 2 3 4	Licensee will provide photo proofs of baby gates to LPA Perry by POC date.

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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC809 (FAS) - (06/04)

Page: 8 of 11

Document Has Been Signed on 12/18/2023 05:27 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019135
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(b)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, LPAs did not observe no firm mattresses. Cribs were observed to be to have loose articles and objects. LPAs observed objects to be hanging above cribs and attached bumpers to the side of the cribs. LPAs did observe one crib to have a changing table attached to the crib on the top, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/22/2023
	Plan of Correction
1 2 3 4	Licensee will provide photos of corrections made to make infant area free of any objects by POC date of 12/22/23.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above, 3 out of 4 chidrens files did not have immunization available at the time of inspection, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/15/2024
	Plan of Correction
1 2 3 4	Licensee will provide LPA with childrens immizations by poc date of 1/15/23.

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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC809 (FAS) - (06/04)

Page: 9 of 11

Document Has Been Signed on 12/18/2023 05:27 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019135
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(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 evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above, Licensee as well as assistant did not have pediatric cardiopulmonary resuscitation and pediatric first aid as well as Mandated Reporter Training which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/08/2024
	Plan of Correction
1 2 3 4	Licensee and Assistant will provide LPA wth CPR certification and MandatedReporter Training via email once completed by POC date

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above, Licensee and assistant did not have required immunizations which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/08/2024
	Plan of Correction
1 2 3 4	Licensee and Assistant will proof of immunizations via email once completed by POC date.

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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC809 (FAS) - (06/04)

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