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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215379
Report Date: 09/29/2021
Date Signed: 09/29/2021 01:44:12 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: 5DATE:
09/29/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:21 PM
MET WITH:Monica GonzalezTIME COMPLETED:
01:45 PM
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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 9/29/21, at 12:21 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Case Management inspection of the above referenced Family Child Care Home (FCCH) for a change of capacity. LPA met with Monica Gonzalez, Licensee and Noemi Canchola, Assistant, of the FCCH and explained the nature/purpose of the inspection.

During this inspection, LPA and Licensee together toured the an interior and exterior of the FCCH. LPA observed the FCCH's interior and exterior to be free of hazardous materials and/or toxins at the time of the visit, which would pose a danger to the children in care. LPA observed 2 infants and 3 children in care at the time of the inspection.

LPA reviewed the Licensee’s First Aid/ CPR certification which expires on 6/23/2023. LPA observed a regulation fire extinguisher which was purchased on 6/5/2021. LPA reviewed the Licensee’s Mandated Reporter Training certificate, which was completed on 01/20/2020.

On 08/02/2021, the Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH).

This Report Continues on LIC 809C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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: 09/29/2021
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The Santa Maria Fire Department granted a fire clearance following an inspection completed at FCCH on 09/27/2021.

LPA observed that COVID-19 documents were posted.

The home meets Title 22 of CCR requirements for a Large Family Child Care license effective 09/29/2021.

THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.

The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Jimenez. There were no deficiencies cites at this time. LPA observed licensee post the Notice of Site visit FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
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