376626429-6-18-2019-20-CC-ACAN-BD9RFL-20190618125918

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376626429
Report Date: 06/18/2019
Date Signed: 06/18/2019 12:59:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	GONZALEZ, JESSICA FAMILY CHILD CARE		FACILITY NUMBER:	376626429
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	06/18/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Jessica Gonzalez		TIME COMPLETED:	01:15 PM

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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	LPA Adrian Castellon completed an announced pre-licensing inspection on this date. LPA Castellon met with licensee Jessica Gonzalez. Purpose of the visit is to inspect the facility prior to licensure to ensure that the home meets health and safety standards so a large license may be issued. We reviewed child abuse reporting responsibilities, required forms, record keeping requirements and discipline appropriate for child care. Applicant understands that physical discipline/corporal punishment shall never be permitted in the child care operation. A review of records on this date indicates all facility staff or other individuals who require caregiver background checks have received clearances or exemptions. There are civil penalties for failure to obtain fingerprint clearances by the Department of Justice prior to working, living or associating with children in a child care. The facility was toured. There is an operational smoke alarm, fire extinguisher and carbon monoxide detector maintained in the home. Per the applicant, the facility does not maintains a firearm. There are no bodies of water . CPR and first aid certificates are valid. CCL information and forms can be obtained online at website: http://ccld.ca.gov. Applicant was advised that upon receipt of a type “A” deficiency, a licensee shall post and provide copies of the licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility for the next 12 months. The facility is a 5 bedroom, 4 bathroom home. The entire first floor will be used for daycare purposes. The second floor will not be used for care purposes and is barricaded.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Adrian Castellon	TELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GONZALEZ, JESSICA FAMILY CHILD CARE	FACILITY NUMBER: 376626429
	VISIT DATE: 06/18/2019

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A fully fenced backyard will be used for outdoor play. The side yard is off limits and barricaded.

LPA reminds applicant of the following: required departmental documents, supervision, clearances, emergency drills (once every six months), child passenger law, unusual incident/injury reporting, mandated reporting, SIDS,

Shaken Baby Syndrome, and Megan's law. Applicant is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation. New adult immunization requirements have been met. Mandated Reporter training has been discussed.

Incidental Medical Services (IMS) policy was discussed. Facility does not provide care for children who require IMS. 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

The home is in substantial compliance and a large family child care license (capacity 14) may be issued after a final file review.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Adrian Castellon	TELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019

LIC809 (FAS) - (06/04)

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