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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334820565
Report Date: 10/15/2024
Date Signed: 10/15/2024 12:30:44 PM


Document Has Been Signed on 10/15/2024 12:30 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:GOLD/RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
334820565
ADMINISTRATOR:AMY GOLDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 766-5132
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY:14CENSUS: 9DATE:
10/15/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Amy Gold, LicenseeTIME COMPLETED:
12:40 PM
NARRATIVE
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On October 15, 2024, at 9:40 AM Licensing Program Analyst (LPA) Brian Morris and Licensing Program Manager (LPM) Carlos Martinez arrived at the facility to conduct an annual inspection as part of a compliance review. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed:

Normal days and hours of operation are Monday- Friday, 6:00 AM to 6:00 PM
OFF-LIMIT AREAS INCLUDE: Downstairs Bedroom, Entire 2nd Floor, Garage, Pool area and North side of backyard used as a dog run.

The inspection consisted of reviews of the following domain: Physical Plant, Care and Supervision, Records, Facility Administration, Staffing Ratio and Capacity, Personal Rights. The inspection found the facility to be in compliance in these domains.
· The facility is operating within the licensed capacity and appropriate ratios. LPA took a census of 10 children present, 2 of the 12 being infants, with 3 staff supervising.
· The Licensee is present in the home and has ensured that children in care are supervised by 3 staff on 10/15/2024
· When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children,
· A working telephone is present.
· Appropriate fire extinguisher observed, smoke detector and carbon monoxide detector are present and were tested by the Licensee on 10/15/2024.
· All hazardous items are inaccessible, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children
· Storage of poisons is inaccessible to children and locked on 10/15/2024.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Brian MorrisTELEPHONE: 951-218-7031
LICENSING EVALUATOR SIGNATURE:
DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2024
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 10/15/2024 12:30 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: GOLD/RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334820565

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation and record review, the licensee did not comply with the section cited above in 2 out of 5 Staff files reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/29/2024
Plan of Correction
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Licensee will ensure all staff complete Mandated Reporter training and provide copies of the completed certificate to LPA Morris by POC date via email.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation and record review, the licensee did not comply with the section cited above in 2 out of 5 childrens file reviews which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/18/2024
Plan of Correction
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Licensee will ensure all Sleep Log/15-Minute checks are updated and placed in childrens files and provide photos of documents by POC date via email.
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: Carlos MartinezTELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Brian MorrisTELEPHONE: 951-218-7031
LICENSING EVALUATOR SIGNATURE:
DATE: 10/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/15/2024 12:30 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: GOLD/RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334820565

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)(2)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation and record review, the licensee did not comply with the section cited above in 2 out of 5 total file reviews did not have a Sleep Plan for C4 and C5, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/18/2024
Plan of Correction
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Licensee will ensure all Sleep Plans are updated and placed in childrens files and provide photos of documents by POC date via email.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation and record review, the licensee did not comply with the section cited above in 2 out of 5 total file reviews did not have a 15-minute check log for C4 and C5, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/18/2024
Plan of Correction
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Licensee will ensure all 15-Minute checks are updated and placed in childrens files and provide photos of documents by POC date via email
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: Carlos MartinezTELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Brian MorrisTELEPHONE: 951-218-7031
LICENSING EVALUATOR SIGNATURE:
DATE: 10/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2024
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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: GOLD/RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334820565
VISIT DATE: 10/15/2024
NARRATIVE
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LPA confirmed that the fireplace was properly barricaded.
· No guns or weapons present as stated by the Licensee Amy Gold. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· LPA observee that the Stairs are barricaded,
· Home is clean and orderly, with heating and ventilation for safety and comfort on 10/15/2024.
· Safe and appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas are fenced and/ or appropriate supervision is present on 10/15/2024.
· Verification of control of property on file Grant Deed 12/01/2006.
· Pediatric CPR and First Aid Card expire on 08/2025 for all licensees.
· Health & Safety Certificate - completed on 04/20/2008-Zoila & Juan Rodriguez, Amy Gold 04/06/2008
· Mandated reporter General: Amy Gold-10/16/2024.
· Fire clearance: 05/10/2010
· Documentation of fire & earthquake drills to be conducted every six months: Last fire drill on 07/01/2024 at 5:35 PM, Earthquake drill on 07/01/2024.
· Licensees Amy Gold, Zoila Rodriguez, and Juan Rodriguez, understand all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. LPA verified that self-latching gates are in working condition and no repairs required for mesh fencing.
· Children’s files are complete on 10/15/2024
· Staff’s files are complete on 10/15/2024

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Childcare 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.html.com
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Brian MorrisTELEPHONE: 951-218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: GOLD/RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334820565
VISIT DATE: 10/15/2024
NARRATIVE
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Licensee Amy Gold, 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 Childcare 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.

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/ection-process.

Please see LIC 809D for Deficiencies cited on 10/15/2024.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Amy Gold.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Brian MorrisTELEPHONE: 951-218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC809 (FAS) - (06/04)
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