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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215379
Report Date: 07/15/2021
Date Signed: 07/15/2021 02:41:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GONZALEZ FCC AKA MONIQUE DAYCAREFACILITY NUMBER:
426215379
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
07/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Noemi Canchola TIME COMPLETED:
02:50 PM
NARRATIVE
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

On 7/15/2021, at 12:35 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Required Annual Inspection of the Gonzalez Family Child Care Home. LPA met with Noemi Canchola, Licensee's Assistant, and during the visit Porfiria Ibarra, licensee's mother-in-law and Alfonso Reyes, Licensee's father-in-law arrived to the FCCH. The purpose of the visit was discussed with the Assistant and together we toured the inside and outside of the home. The main day care areas are living room, dining room, kitchen, and bathroom.

LPA observed the day care area to be clean and orderly. LPA observed age appropriate books, toy, games, tables and chairs. LPA observed the off-limits areas which include the 4 bedrooms, 2 bathrooms and garage were observed to be secured with doorknob covers, locks and gate making the off-limit areas inaccessible to children in care. The backyard is completely fenced. No bodies of water were observed.

LPA observed 6 children, and 2 infant napping at the time of the inspection. LPA observed one pack-N-play in the living room with infant #1 asleep in the pack-N-play. Infant #2 was being carried by the assistant. LPA asked the assistant where does infant #2 sleep when infant #1 is asleep in the pack-N-play. The assistant stated a floor mat is placed on the floor between the couch and dining room table, the infant is then placed to sleep on the floor mat for napping.

The assistant stated that there are no weapons/ammunition in the home. The assistant stated that licensee does not hold a foster family license. LPA reviewed the facility roster. The fire extinguisher was observed and

THIS REPORT CONTINUES ON LIC 809C & LIC 809D
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GONZALEZ FCC AKA MONIQUE DAYCARE
FACILITY NUMBER: 426215379
VISIT DATE: 07/15/2021
NARRATIVE
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was purchased on June 5, 2021. The assistant stated that the carbon monoxide detector and smoke alarm were tested on March 1, 2021. Licensee and assistant are current with immunization required per SB 792. The last Safety drill was conducted and documented on June 29, 2021. The assistant is current with CPR and First Aid which expires June 23, 2023.

Licensee is not providing Incidental Medical Services. 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: htttp://www.ada.gov/childqanda.htm

Licensee's assistant completed the Mandated Reporter Training on May 5, 2021, required per AB 1207. LPA reviewed with Licensee the Safe Sleep Regulation(PIN 20-24). LPA provided a Handout for Reporting Child Abuse and Neglect Training provided on line at www.ccld.ca.gov. Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs), Title 22 & Health & Safety Codes which can be accessed on-line athttps://www.cdss.ca.gov/inforesources/child-care-licensing

Today, deficiency cited under Title 22 Division 12 Appeal rights given.


Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GONZALEZ FCC AKA MONIQUE DAYCARE
FACILITY NUMBER: 426215379
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/16/2021
Section Cited

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Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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This requirement was not met as evidenced by the following: Based on the LPA's observation of 2 infants present a the time of the inspection with 1 pack-n-play, and the assistant stated a floor mat is placed on the floor between the couch and dining room table, the infant is then placed to sleep on the floor mat on the floor.
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This poses a potential risk to the health, & safety to children in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2021
LIC809 (FAS) - (06/04)
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