543909572-7-31-2019-04-CC-JTHN-BELPN4-20190731112719

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543909572
Report Date: 07/31/2019
Date Signed: 07/31/2019 11:27:25 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	GONZALEZ, STEPHANIE FAMILY CHILD CARE		FACILITY NUMBER:	543909572
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	07/31/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Stephanie Gonzalez		TIME COMPLETED:	11:30 AM

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	An unannounced Annual/Random Inspection was conducted today by Licensing Program Analyst (LPA) Jessika Thompson. LPA met with Licensee Stephanie Gonzalez and a census was taken. A tour of the facility was made. Background clearances were discussed and licensee signed LIS531 indicating all adults residing and/or providing care and supervision have a criminal record clearance. Licensee has current pediatric CPR and First Aid, expiring 10/07/19. The home is clean and orderly, with heating and ventilation for safety and comfort. Off-limit rooms are made inaccessible by use of spinning plastic door knob covers. The backyard is an off-limit, inaccessible area of the home. Outdoor play takes place in the unfenced front yard and is supervised 100% of the time by the licensee or care giver, as required. Safe, healthful, and comfortable accommodations, furnishings, toys and equipment were observed. Licensee has one large dog that is kept in the off-limit backyard. Licensee understands she is liable for any action taken by family pet if/when accessibility is gained by children in care. A current roster of children in care is maintained and updated accordingly. LPA verified that immunization records are maintained and licensee updates records for children in care. Licensee provides a copy of Parent’s Rights to all parents and/or child’s representative. Licensee maintains proof of immunization, for herself, within the family child care home. Licensee has proof of Child Abuse Mandated Reporter training, completed 08/23/18. Licensee understands certification of Child Abuse Mandated Reporter certification must be renewed every two years. Licensee ensures children in care are supervised at all times. Fire and disaster drills are conducted at least once every six months, documented with the date and time. The last two fire & disaster drills occurred 04/12/19 and 06/17/19. Licensee states there are no firearms or ammunition are in the home. Detergents, cleaning compounds, medications, and other items which could pose a danger to children are stored where they are inaccessible to children. Facility has required fire extinguisher and smoke detector, both meet State Fire Marshall standards. Facility has at least one functioning carbon monoxide detector that meets statutory requirements. No bodies of water observed in or on the premises. Safe sleep practices for infants was discussed and LPA provided the licensee with a handout. (Continued on LIC809-C)

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2019

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GONZALEZ, STEPHANIE FAMILY CHILD CARE	FACILITY NUMBER: 543909572
	VISIT DATE: 07/31/2019

NARRATIVE

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Lead safety was discussed, and LPA provided Licensee with a brochure. Licensee understands that lead safety information must also be provided to parents and/or authorized representatives of children in care.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. Licensee stated that currently she does not have any children enrolled requiring IMS. Licensee understands that if/when any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Hours of operation are Monday through Friday from 7:30 AM to 5:15 PM and as arranged; less than 24 hours. Licensee is reminded of inspection authority by employees of the Department at any time, with or without advance notice. Licensee was advised that forms and updated information may be obtained on the CCLD website (www.ccld.ca.gov). Licensee was also advised that it is her responsibility to stay current with regulations. Provider Information Notices were discussed; Licensee stated she is signed up to receive licensing updates via email.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2019

LIC809 (FAS) - (06/04)

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