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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543909572
Report Date: 05/15/2020
Date Signed: 05/15/2020 03:51:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:GONZALEZ, STEPHANIE FAMILY CHILD CAREFACILITY NUMBER:
543909572
ADMINISTRATOR:GONZALEZ, STEPHANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 393-6930
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:14CENSUS: 6DATE:
05/15/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Stephanie GonzalezTIME COMPLETED:
11:05 AM
NARRATIVE
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On 05/15/20, Licensing Program Analyst (LPA) Jessika Thompson conducted a Case Management tele-inspection. The purpose of this inspection was to discuss a deficiency found during a complaint investigation that transpired on 10/29/19. This matter was previously addressed during the aforementioned complaint investigation; however, due to the nature of the prior complaint allegation, the citation was amended, thereby requiring the generation of this report.

Upon interview, the licensee stated that her mother, Linda Gonzalez, had assisted in caring for children at the FCCH, on more than one occasion, before obtaining a criminal background clearance.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC809-D)

Appeals rights for this deficiency were not provided, as the licensee has appealed this citation previously, and the appeal was subsequently denied.



Licensee was advised to make this licensing LIC809 and LIC809-D report accessible to the public and to provide copies of the report to parents/legal guardians of children in care and parents/legal guardians of children newly enrolled until 10/29/20, totaling 12 consecutive months. It is hereby noted that the licensee has been in cooperation with posting requirements and issuance of reports to parents/legal guardians regarding this matter since 10/29/19. Licensee is to keep Acknowledgement of Receipt of Licensing Reports (LIC 9224) in each child's file at the facility.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2020
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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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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/15/2020
Section Cited

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption
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as required by the Department. This requirement was not met, as upon interview, the licensee stated that her mother, Linda Gonzalez, had assisted in caring for children at the FCCH, on more than one occasion, before obtaining criminal background clearance. A civil penalty of $200 was assessed.
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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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2020
LIC809 (FAS) - (06/04)
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