334820565-10-13-2022-10-CC-SBRR-CK6SHK-20221013135340

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334820565
Report Date: 10/13/2022
Date Signed: 10/13/2022 01:53:49 PM

Document Has Been Signed on 10/13/2022 01:53 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	GOLD/RODRIGUEZ FAMILY CHILD CARE		FACILITY NUMBER:	334820565
ADMINISTRATOR:	AMY GOLD		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 766-5132
CITY:	WINCHESTER	STATE: CA	ZIP CODE:	92596
CAPACITY:	14	CENSUS: 12	DATE:	10/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:19 AM
MET WITH:	Zoila Rodriguez, Juan Rodriguez and Amy Gold		TIME COMPLETED:	02:00 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	On 10/13/2022 at 11:19 AM Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct an annual inspection. LPA was greeted by Staff 1 (S1 on the confidential names list) and granted entry to tour the facility, inside and out. LPA reviewed records and observed and/or discussed the following: Present during the inspection were licensees Zoila & Juan Rodriguez, 3 staff and licensee Amy Gold, was away from the facility and due to return. S1 lead the inspection on behalf of the licensees. At Approximately 12:32 PM, Licensee Amy Gold arrived to take over the tour. 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 12 children present, 3 of the 12 being infants. · The Licensee is present in the home and has ensured that children in care are supervised by 3 staff on 10/13/2022. · When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children on 10/13/2022. · A working telephone is present. · Appropriate fire extinguisher inspection tagged 09/26/2022, smoke detector and carbon monoxide detector are present and were tested by the Licensee on 10/13/2022.

SUPERVISOR'S NAME: Pauline Beschorner	TELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: GOLD/RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 334820565
	VISIT DATE: 10/13/2022

NARRATIVE

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· 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 10/13/2022.
· There is a properly barricaded fireplace on 10/13/2022.
· No guns or weapons present as stated by the Licensees Zoila Rodriguez and Juan Rodriguez. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· Stairs are barricaded on 10/13/2022.
· Home is clean and orderly, with heating and ventilation for safety and comfort on 10/13/2022.
· 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 10/13/2022.
· Verification of control of property on file Grant Deed 12/01/2006.
· Pediatric CPR and First Aid Card expire on 08/2023 for all licensees.
· Health & Safety Certificate - completed on 04/20/2008-Zoila & Juan Rodriguez, Amy Gold 04/06/2008
· Mandated reporter General: 01/02/2020; AB 1207 Child Care started: 05/02/2022 3 hours, exam not taken.
· Fire clearance: 05/10/2020
· Documentation of fire & earthquake drills to be conducted every six months: Last fire drill on 09/30/2022 at 5:35 PM with 2 children present, Earthquake drill on 07/12/2022 with 4 children.
· There are no bodies of water on 10/13/2022. Licensees Amy Gold, Zoila 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 10/13/2022.
· Staff’s files are complete on 10/13/2022

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 Child Care Homes Section 102417.

SUPERVISOR'S NAME: Pauline Beschorner	TELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: GOLD/RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 334820565
	VISIT DATE: 10/13/2022

NARRATIVE

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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.htm

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 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 Susan Brewer, discussed the safe sleep regulations with licensee Amy Gold 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.

Deficiencies not cited on 04/13/2022.

No civil penalties issued on 10/13/2022.

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: Pauline Beschorner	TELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

LIC809 (FAS) - (06/04)

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