376629239-12-7-2021-20-CC-DSTS-C9H4LF-20211207181152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376629239
Report Date: 12/07/2021
Date Signed: 12/07/2021 06:11:59 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:	AGUILAR-GONZALEZ, G. & GUZMAN HERNANDEZ, A. FCC		FACILITY NUMBER:	376629239
ADMINISTRATOR:	GLADYS A. & ALEJANDRO G.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 633-4473
CITY:	BONITA	STATE: CA	ZIP CODE:	91902
CAPACITY:	14	CENSUS: 0	DATE:	12/07/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	05:00 PM
MET WITH:	Gladys Aguilar		TIME COMPLETED:	06:15 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 12/07/2021 at 4:50 PM, Licensing Program Analyst (LPA) Dana Stevens, conducted an announced pre-licensing inspection with applicants Gladys Aguilar-Gonzlez and Alejandro Guzman-Hernandez for the purpose of Change of Location. This single story, three bedroom, two and half bath home was inspected to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Applicant will use the following areas for child care: living room, kitchen,dining room and half bathroom. Off limits areas include: All bedrooms, hall bathroom and garage. They are made inaccessible to day care children through the use doorknob covers, and a safety gate. Applicant will utilize the backyard for outdoor activities, it is properly fenced. The fireplace is screened. The home has an in-ground pool that is surrounded by a fence, with self-latching, self-closing gate that swings away from the pool and meets Title 22 requirements. The fire extinguisher is rated 4A 60B:C and is located in the living room. The combination smoke/carbon monoxide detector meets requirements and is operational. All poisons, detergents, cleaning compounds, and medicines are inaccessible to children in care and are located in off limit areas with cupboard latches and door locks and secured out of reach of children. Children’s toys and play equipment are available. The applicant has a working telephone/cell phone. Applicant indicated there are no firearms or other weapons in the home. Applicant maintains documentation of proof of control of property for review by the Department. Applicant completed Mandated Reporter AB1207 training and 8 hours of Preventative Health. Pediatric CPR and First Aid certifications expire on 06/2023. Required documents are posted. Applicant and adult residents in the home have criminal record clearances and/or exemptions on file.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

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

FACILITY NAME: AGUILAR-GONZALEZ, G. & GUZMAN HERNANDEZ, A. FCC	FACILITY NUMBER: 376629239
	VISIT DATE: 12/07/2021

NARRATIVE

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Licensee 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. Immunization records per SB792 were reviewed and are in compliance. LPA advised that prior to making alterations or additions to the home or grounds, the applicant shall notify the Department of the proposed change. Applicant states they are financially secure to operate a family child care home for children and will comply with all regulations and laws governing family child care homes. The hours of operation are Monday through Friday, 24 hours a day.

Applicant does not plan on providing Incidental Medical Services (IMS) to clients at this time. 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

LPA discussed the maximum capacity for a large family child care home. Landlord consent is on file.

Applicant is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248.

A Regular Large Family Child Care Home license maybe issued upon final file review. Exit interview was conducted and copy of report was provided to applicant.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

LIC809 (FAS) - (06/04)

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