543910568-10-29-2019-04-CC-JTHN-BHEUGQ-20191029153445

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543910568
Report Date: 10/29/2019
Date Signed: 10/29/2019 03:35:28 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 CARE		FACILITY NUMBER:	543910568
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	10/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Angelina Gonzalez - Licensee		TIME COMPLETED:	03:45 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	An unannounced Annual/Random Inspection was conducted today by Licensing Program Analyst (LPA) Jessika Thompson. LPA with met with Licensee Angelina Gonzalez and a census was taken. A tour of the facility was made. Background clearances were discussed, and licensee confirmed all adults residing and/or providing care and supervision have a criminal record clearance. This is a two story home with a child safety gate located at the bottom of the stairs making the second floor off-limits to day-care children. Licensee has current pediatric CPR and First Aid that expires on 06/16/20. The home is clean and orderly, with heating and ventilation for safety and comfort. Safe, healthful, and comfortable accommodations, furnishings, toys and equipment were observed. There is a working telephone. Licensee one small dog that is inaccessible to children, by means of a gated area in the backyard. Licensee accepts full liability for any action taken by family pet. 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 representatives. Licensee ensures that children in care are supervised at all times. Fire and disaster drills are conducted at least once every six months, and documented with the date and time. Licensee states there are no firearms or ammunition in the home. A pool was observed and is fenced in accordance with Title 22 Regulations. 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 a functioning carbon monoxide detector that meets statutory requirements. Licensee understands children may not be left in parked vehicles. Safe sleep practices for infants was discussed and LPA provided the licensee with a handout. Lead safety was discussed. Licensee understands that lead safety information must also be provided to parents and/or authorized representatives of children in care. Provider Information Notices were discussed, and licensee is subscribed to receive updates via email. Licensee is aware that forms and updated information may be obtained on the Community Care Licensing Division's website, www.ccld.ca.gov (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: 10/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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, ANGELINA FAMILY CHILD CARE	FACILITY NUMBER: 543910568
	VISIT DATE: 10/29/2019

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
26
27
28
29
30
31
32

Licensee has proof of Child Abuse Mandated Reporter training, completed 06/25/18. Licensee was advised that this certification must be renewed every two years. Licensee understands that it is her responsibility to stay current with regulations. Licensee is urged to visit the U.S. Consumer Product Safety Commission web page at www.cpsc.gov to ensure that equipment purchased for the day care have not been recalled.

Incidental Medical Services (IMS) are not currently being provided. Licensee was advised that if/when any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Licensee was advised that the Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

Hours of operation are Monday through Friday from 7:15 AM to 5:30 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.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies were cited 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: 10/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2