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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543910568
Report Date: 04/26/2019
Date Signed: 04/26/2019 01:52:41 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, ANGELINA FAMILY CHILD CAREFACILITY NUMBER:
543910568
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
04/26/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Angelina GonzalezTIME COMPLETED:
11:20 AM
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On this date, Licensing Program Analyst (LPA) Kathy Pacheco conducted an announced inspection and met with Licensee, Angelica Gonzalez. Licensee requested an inspection regarding building an in-ground swimming pool in the backyard. LPA discussed the regulations regarding required fencing of the swimming pool. Licensee stated she understood the regulation requirements. LPA and Licensee also discussed the possibility of making the downstairs bedroom window inaccessible by converting the window to solid glass. Licensee stated once the swimming pool is completed, she will send an updated facility sketch to Community Care Licensing, along with pictures of the completed swimming pool and the required fencing. Licensee will also send pictures of the downstairs bedroom window if it is made inaccessible with solid glass.

During the inspection, LPA also provided Licensee with information regarding the California Department of Social Services (CDSS) Provider Information Notices (PINs) communication system; AB 2370, Chapter 676, Statutes of 2018, requiring child care providers to inform parents and/or guardians with lead safety information, and other important resources and information links offered on the CDSS website.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2019
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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