393619906-7-15-2022-53-CC-ESIA-CGCRBR-20220715125309

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393619906
Report Date: 07/15/2022
Date Signed: 07/15/2022 12:53:14 PM

Document Has Been Signed on 07/15/2022 12:53 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	GONZALES, VALENE		FACILITY NUMBER:	393619906
ADMINISTRATOR:	GONZALES, VALENE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 915-9786
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	14	CENSUS: 12	DATE:	07/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Valene Gonzales		TIME COMPLETED:	01:20 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 Friday, July 15th, 2022, at 10:30am, Licensing Program Analyst (LPA) Elvira Sierra met with the Licensee, Valene Gonzales for the purpose of an unannounced annual inspection. Present in the facility was License, and her assistant caring for 12 children. Two of the children were Licensee own children. Facility hours of operation are M-F from 07:00am to 05:00pm. Capacity specified on the license was met on today’s inspection. Licensee stated that no new residents moved into the home since licensure. A health and safety inspection was conducted in all areas accessible to children. Off-limit areas are; all bedrooms, upstairs, shed, side barbeque area in the backyard and garage. Licensee stated she is not using the backyard at the moment because is under renovation. Licensee acknowledged that children may never enter these off-limit areas. LPA observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Rights. Home is clean and appropriately ventilated. Facility maintains a working phone, 2A10BC fire extinguisher, and functioning smoke/carbon monoxide detector. Age appropriate toys and reading material were observed. Licensee stated there are no weapons in the home and no bodies of water were observed. Stairs leading to the upstairs level is gated. Toxic and hazardous items are inaccessible to children. The fireplace in the home is appropriately barricaded to prevent access by children. Outdoor play area is fence for supervision. At 11:40am, LPA reviewed 10 children records. LPA observed all required forms for the children in care are complete and maintained in the file. Current in person EMSA CPR and First Aid certification was verified and expires 11/23. LPA observed a current roster and fire drills are conducted at least once every six months and are properly log. 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. Report continues on subsequent page 809C--

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: GONZALES, VALENE	FACILITY NUMBER: 393619906
	VISIT DATE: 07/15/2022

NARRATIVE

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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
LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days. LPA posted the Notice of Site Visit on today’s inspection. Exit interview conducted and report was reviewed with the Licensee, Valene Gonzales.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

LIC809 (FAS) - (06/04)

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