367700188-4-14-2021-12-CC-LTMR-C23Q3Y-20210414114930

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700188
Report Date: 04/14/2021
Date Signed: 04/14/2021 11:49:58 AM

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:	04/14/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Orbelina Moran and Hilda Gonzalez		TIME COMPLETED:	11:30 AM

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's Orbelina Moran and Hilda Gonzalez who guided analyst on a tour of the facility for a Case Management - Other Change of Location/Capacity Increase Inspection Tele Visit (virtual). The purpose of the inspection is to verify corrections. LPA verified the following: 1. Parent board and posting at front entrance (COVID-19 and Licensing)---Required posting were observed. 2. Yellow play house has wood chipping---LPA observed play house has no wood chipping that could cause splinter 3. Revise sketch to include location of rooms and backyard division----LPA received revised sketch 4. Off limits bedroom (#2) to be made inaccessible---LPA verified room has a safety knob (door) 5. Garage and bedroom #3 to be inspected----Bedroom #3 has a safety knob (door). Key lock for garage. Access to the storage room (through the backyard only) has a key lock and access from the storage room to the garage has a key lock. Ready for licensure for a Change of Location and a Large Family Child Care License with capacity of 14 children. Exit interview conducted and a copy of this report will be emailed to Licensee's Orbelina Moran and Hilda Gonzalez (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: 04/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021

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: 04/14/2021

NARRATIVE

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The following was discussed with the Licensee's:
Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; Licensee's were reminded that 100% supervision is required at all times to children in care; Licensee's were made aware that it is her/their responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

Licensee's were advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

Licensee's were advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021

LIC809 (FAS) - (06/04)

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