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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334815756
Report Date: 09/29/2020
Date Signed: 09/29/2020 03:23:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GASCON FAMILY CHILD CAREFACILITY NUMBER:
334815756
ADMINISTRATOR:GASCON, CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 564-8479
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY:14CENSUS: 5DATE:
09/29/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Carmen Gascon, Licensee TIME COMPLETED:
02:30 PM
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September 29, 2020 Due to COVID-19, Licensing Program Analyst (LPA) Sharleen Robinson conducted a Tele-inspection with Licensee Carmen Gascon Via FaceTime.
While visiting the facility for another reason, LPA observed an infant in care, the infant was napping in a play pen, laying on their stomach with a blue blanket on them. Licensee stated the child is attached to the blanket and their representative would like for them to have it when they nap.

LPA advised the licensee of infant safe sleep regulations. 102425(b) infant safe sleep Cribs or play yards shall be free from all loose articles and objects. 102425(b)The provider shall place infants up to 12 months of age on their backs for sleeping.

Licensee stated she was unaware of the Safe Sleep regulations. LPA discussed and provided Licensee with a copy of the Provider Information Notice (PIN ). LPA also provided the licensee with form LIC 9227 Individual Infant Sleeping Plan. LPA explained LIC 9227 is to be completed for each infant up to 12 months of age that the Licensee has in care and included in the infant's file at the facility. The infant awoke during the visit. See LIC9102 for technical violation.

An exit interview was conducted via FaceTime LPA Robinson provided the licensee with a copy of this report via email, LPA asked the licensee to acknowledge receipt of the email. An electronic “read receipt” was also attached. The electronic read receipt of the emailed report acknowledges receipt of this report. A copy of this report was emailed to the Licensee during this Tele-inspection on September 29, 2020.

A copy of this report must be made available upon request, to the public, for 3 years.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 233-7183
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020
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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