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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622222
Report Date: 01/08/2020
Date Signed: 01/08/2020 01:08:23 PM

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-GRAY, DENYSEFACILITY NUMBER:
393622222
ADMINISTRATOR:GONZALES-GRAY, DENYSEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 478-7399
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:14CENSUS: 7DATE:
01/08/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Denyse Gonzales-GrayTIME COMPLETED:
01:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Charlotte Baney met with licensee for an unannounced random annual inspection and toured areas of the home accessible to children in care. Off-limit areas include: upstairs and garage. Licensee acknowledged that children may never enter these off-limit area. Licensee stated there are no new residents in the home since licensure. All Adult residents have criminal record clearances.
LPA observed current CPR/First Aid certificates which expire on 7/20. LPA discussed recent changes in licensing requirements, including the posting of licensing inspection notices and reports and Parent Notification Requirements. LPA reviewed some children’s files. LPA observed fire drills were conducted at least once every six months and documented.
LPA observed that there were no hazardous items accessible to children. LPA observed that cleaning materials were inaccessible. Licensee stated there are no weapons in the home. Fire extinguisher, smoke detector and carbon monoxide detector meet regulation. Toys appear to be safe. The backyard is fenced and gated. There are no bodies of water observed.
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 observed current Mandated Reporter Training and licensee immunization's in file.
LPA checked facilities fees and confirmed that it is up to date.
No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the Licensee and provided copies. An exist interview was conducted.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Charlotte BaneyTELEPHONE: (916) 216-7791
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
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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