444406219-5-2-2022-07-CC-CNEN-CE2TMH-20220502145111

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444406219
Report Date: 05/02/2022
Date Signed: 05/02/2022 02:51:18 PM

Document Has Been Signed on 05/02/2022 02:51 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	GONZALEZ, ELIZABETH		FACILITY NUMBER:	444406219
ADMINISTRATOR:	GONZALEZ, ELIZABETH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 761-2190
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 12	DATE:	05/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Elizabeth Gonzalez		TIME COMPLETED:	03:00 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	Licensing Program Analyst (LPA), Cortney Nelson, met with Licensee, Elizabeth Gonzalez, for an unannounced Required- 1 Year Inspection. LPA was granted access to the home by the Licensee and toured both indoors and outdoors during the inspection. Upon arrival, there were 12 children (10 preschool-age/ 2 school-age), Licensee, and Assistant, Tina Sousa, present, which is compliant with the home license capacity and ratio requirements. LPA observed all required postings near the entrance to the home. Hours of operation for the facility are Monday – Friday, 7:00AM - 5:00PM. Licensee states that adults, over the age of 18, residing in the home are: herself, her spouse (Jose Gonzalez), and her son (Ryan Gonzalez). Licensee states that son, Ryan, will be returning home commencing this Friday (5/9). LPA advised that Ryan is fingerprint cleared before returning home and provided Licensee with Livescan sheet (LIC9163). All adults currently residing in the home have Criminal Background Check Clearance and signed Criminal Record Statements (LIC508). 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. LPA reviewed facility roster (LIC9040) and fire/disaster drill log during todays inspection. The last fire/disaster drill was conducted on 2/4/2022, which is compliant with the six-month requirement for homes. LPA observed a fully charged 3A40BC fire extinguisher, functioning smoke detector and carbon monoxide detector. Smoke and carbon monoxide detectors are connected to the home and were recently installed. Licensee states that she does not currently administer medication, however one child has Incidental Medical Services for EpiPen. LPA discussed IMS plan with Licensee and Licensee will submit for review. The Licensee states that there are no weapons or firearms in the home.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GONZALEZ, ELIZABETH	FACILITY NUMBER: 444406219
	VISIT DATE: 05/02/2022

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 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

Indoor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Off-limits areas inside the home: 3 bedrooms and 1 bathroom. There is a detached, finished garage space that is also not utilized by day care children. Licensee has wood burning stove in day care area with waiver that will not be used while children are present. LPA observed sufficient age-appropriate materials, toys, and play equipment in the home. Drinking water is readily available for children in the facility via water dispensers and cups. All food provided to children is cooked at the facility. The bathroom in the home is clean, sanitary, and operable. LPA advised Licensee to use paper towels, rather than cloth towel, for hand drying and COVID preventative measures. The Licensee has a working telephone (cell phone) in the facility.

The backyard area of the home was inspected. LPA observed sufficient play-equipment and supplies for the children that are in good condition and age-appropriate. There is a functioning water fountain outside for children to utilize and functioning sink for hand washing prior to returning inside the home. Off-limit areas outside of home include: right side yard beyond the fenced area. No outdoor bodies of water were observed during todays inspection.

LPA discussed Safe Sleep regulations with Licensee, including Individual Infant Sleep Plan (LIC9227) for infants under 1 year of age and documented nap checks for children under 2 years of age.

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.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GONZALEZ, ELIZABETH	FACILITY NUMBER: 444406219
	VISIT DATE: 05/02/2022

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12 children’s files were reviewed during todays inspection and all required documents were present. LPA advised Licensee on required nap documentation for infants (under 2) in care. 2 staff files (Licensee & Assistant) were reviewed and all required documents were present. LPA advised Licensee that all employees caring for children must have required immunization record (MMR, tDap, and flu). There is at least one staff member present with current CPR/First-Aid that expires 10/2023 and current Mandated Reporter Training that expires on 10/10/2023. LPA reminded Licensee that Mandated Reporter and CPR/First-Aid training must be renewed every 2 years.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The Licensee states that she does not transport any day care children. LPA reminded Licensee that children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Exit interview conducted and report was reviewed with the Licensee, Elizabeth Gonzalez.

As a result of todays inspection, deficiencies were cited, see 809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/02/2022 02:51 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GONZALEZ, ELIZABETH	FACILITY NUMBER: 444406219
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in 1 room of the day care home which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/03/2022
	Plan of Correction
1 2 3 4	Licensee moved items which could pose a danger if readily available to children from kitchen drawers to an area inaccessible to children during todays inspection. LPA advised Licensee to check all kitchen drawers and cabinets for any items that may need to be relocated and submit documentation.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, interview, and observation, the licensee did not comply with the section cited above for 1 staff member, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2022
	Plan of Correction
1 2 3 4	Licensee will submit proof of MMR (measles, mumps, rubella) immunization for assistant (Tina Sousa) by 5/9/2022.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

LIC809 (FAS) - (06/04)

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