367700154-4-6-2022-12-CC-DMAX-CD8T8W-20220406143102

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700154
Report Date: 04/06/2022
Date Signed: 04/06/2022 02:31:14 PM

Document Has Been Signed on 04/06/2022 02:31 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	GONZALES FAMILY CHILD CARE HOME		FACILITY NUMBER:	367700154
ADMINISTRATOR:	DIANE GONZALES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 936-4429
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92407
CAPACITY:	14	CENSUS: 14	DATE:	04/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Diane Gonzales		TIME COMPLETED:	02:45 PM

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Licensing Program Analyst (LPA), Maddox met with with Licensee, Diane Gonzales for the purpose of conducting an unannounced Annual inspection. Present during this inspection were Licensee, her Assistant, Licensee's Husband and 14 children with , LPA verified there were 2 School age children included in the ratio. This is a 2 story home with 5 bedrooms, 3 bathrooms. Family members residing in the home include 2 adults 1 child. All adults in the home (and Assistant) have fingerprint clearances and exams for T.B., LPA verified licensee and Assistant have required immunization's. There are no pools, spas or any other bodies of water observed on the premises. Main area of care is conducted in the family room, dining area, 1 bathroom, and backyard. Children will use the bathroom in the hallway located near the entrance of the home. Off limit areas include the entire upstairs.

Physical Plant: Home is clean and orderly, fireplace is inaccessible, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector, operable Fire Extinguisher (2A10BC). LPA observed a child barricade in place on the stairs. There is a designated area for ill child(ren), there are no weapon/firearms. LPA verified current telephone number. Cleaning compounds inaccessible to children via child safety latch. Medications are inaccessible to children (located upstairs). LPA did not observe any recalled or any prohibited items in the home.

Kitchen: The following are inaccessible - Sharp utensils, lighter and/or matches, alcohol in the home is inaccessible to children.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GONZALES FAMILY CHILD CARE HOME	FACILITY NUMBER: 367700154
	VISIT DATE: 04/06/2022

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Bathroom: LPA verified hazardous items are inaccessible to children in car (i.e. air freshener, razor blades, soap, mouthwash, shampoo, razor, nail polish. Toilets and faucets are clean, safe and operable. Bathtub and shower are free of hazards.

The backyard is completely fenced. There are 2 Chocolate Labs on the premises.
licensee has current CPR and First Aid training (exp 2/2024). Per applicant, there are no weapons or firearms of any kind on the premises. The required fire extinguisher (2A 10BC), smoke detector, and carbon monoxide devises were are present and in operable condition. Licensee has maintained and has documented Emergency Disaster drills no less than twice a year.

******Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care 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.htm - Not at this time

LPA toured a sampling of Children files today and verified fingerprint clearances for adults in the home. Licensee is reminded to report any Unusual Incidents via phone within 24 hours and the written report within 7 days

The On Duty Worker is available for questions at 661-202-3318 Monday through Friday 8am-5pm. There were no violations of Title 22 Regulations noted. Exit Interview conducted a copy of this report is discussed and left at the facility.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

LIC809 (FAS) - (06/04)

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