367700188-4-5-2021-12-CC-LTMR-BZST8D-20210405143009

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700188
Report Date: 04/05/2021
Date Signed: 04/05/2021 02:30:46 PM

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:	MORAN AND GONZALEZ FAMILY CHILD CARE		FACILITY NUMBER:	367700188
ADMINISTRATOR:	MORAN, ORBELINA, GONZALEZ,		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 393-4999
CITY:	HESPERIA	STATE: CA	ZIP CODE:	92345
CAPACITY:	14	CENSUS: 0	DATE:	04/05/2021
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	11:02 AM
MET WITH:	Orbelina Moran		TIME COMPLETED:	01:18 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	Licensing Program Analyst (LPA) Thompson-Miller conducted a Tele-Visit with Licensee Orbelina Moran who guided analyst on a tour of the facility for a Case Management - Other Change of Location Inspection Tele Visit (virtual). Licensee Hilda Gonzalez not present during the inspection. This is a single story 3 bedroom, 2 bathroom home with kitchen/dining, living/family room, laundry room, storage room (access to garage-incomplete construction) and garage. There is no pool/or body of water on the premises. Fire Safety Inspection Request (STD850) granted for 14 children. Family members residing in the home include three adults (Orbelina Moran, Hilda Gonzalez and spouse (Fredy) and one child. Orbelina Moran two adult children are in college and will visit (fingerprint cleared and associated). Days/hours of operation will be Monday through Friday from 6AM to 6PM. Incidental Medical Services (IMS) policy was discussed. Physical Plant: Home is clean and orderly, fireplace screened, age appropriate toys and play equipment, working smoke detector and carbon monoxide, LPA observed required fire extinguisher, no one smokes in the home, no prohibited items in the home. There is an designated area for ill child(ren) as necessary, no weapon/firearms, working telephone (cell), fire extinguisher proper size and ready for use, poisons, medication and cleaning items inaccessible to children. Off limits includes laundry room (key lock), bedroom #2 and #3, kitchen, storage room and garage. Window covering in child care room (living room at entrance on left) cords are tied and out of reach (inaccessible) to children. Kitchen: The following are inaccessible: Sharp items, plastic bags, cleaning items, no chemicals in the kitchen were observed accessible. Sharp items and knives (magnet lock cabinet). Medication in off limits bedroom. Some kitchen cabinets have magnet lock. Child Care restroom: The following are inaccessible: mouthwash, shampoo, razor, nail polish. LPA observed hand washing flyer in restroom. Toilet and faucet is clean and operable and home has a refrigerator/freezer.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

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: MORAN AND GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 367700188
	VISIT DATE: 04/05/2021

NARRATIVE

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Outdoor: The play area is clear and clean of debris, play area is fenced and gated all around, no body of water on the premises. The backyard is divided into two section one for child care and one that is off limits. The child care play yard is fenced and has age appropriate toys and equipment. The off limits back yard section is fenced and gated (key lock). Licensee's are reminded to supervise children at all times during outside play. There are no pets. Parents will enter at the front entrance, sign in/out logged, child temperature reading taken and logged and hand sanitizing will be conducted.

Advisory/Other: First Aid kit with supplies readily available. CPR/First Aid expire 07/14/21. Preventative Health & Safety including Nutrition and Lead Poisoning (01/10/21) completed. Children will nap on cots and playpens are available. No prohibited items observed. It is recommended that prohibited items not be used, as they may pose a danger to children. Windows are free from cracks. No recalled items observed.

Documents Provided and or Discussed: IMS, Safe Sleep, Capacity/Ratio

Names of all adults living in the home: All adults living/residing in the home are fingerprint cleared and associated.

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

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

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: MORAN AND GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 367700188
	VISIT DATE: 04/05/2021

NARRATIVE

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Before licensure the following must be completed:
1. Parent board and posting at front entrance (COVID-19 and Licensing)
2. Yellow play house has wood chipping
3. Revise sketch to include location of rooms and backyard division
4. Off limits bedrooms (#2) to be made inaccessible
5. Garage and bedroom #3 to be inspected

Once corrections have been verified, the application for a small Family Child Care Home will be submitted for approval with a maximum capacity of 6 or 8 with parent notification. Applicant advised that all corrections are due within 30 days or the application may be withdrawn.

Exit interview conducted and a copy of this report will be emailed to Licensee Orbelina Moran (due to COVID-19). The read receipt is in lieu of a signature.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC809 (FAS) - (06/04)

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