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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543910607
Report Date: 10/17/2019
Date Signed: 10/17/2019 11:53:36 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, NORMA FAMILY CHILD CAREFACILITY NUMBER:
543910607
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
10/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Norma GonzalezTIME COMPLETED:
12:10 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Ruby Ocegueda and Kathy Pacheco conducted an unannounced annual inspection. LPAs met with Norma Gonzalez who provided a tour of the home, inside and outside. Rooms inspected were the kitchen, dining room, living room and one bathroom accessible to children in care. There are “no bodies of water” in this home. Firearms and ammunition were properly stored. There were no Poisons observed. LPA reminded licensee that poisons should be kept locked. Cleaning compounds were inaccessible to children. Fireplace was inaccessible to children. The fire extinguishers, smoke detectors, and carbon monoxide indicator were observed to meet Community Care Licensing (CCL) regulations. The home was kept clean and orderly, with heating and ventilation for safety and comfort.. This home did not have stairs present. Safe toys and play equipment were observed. Licensee had a working telephone and the above telephone number was verified. Adequate supervision was being provided during this inspection. Outdoor play areas were fenced or supervised by the licensee or care giver. Capacity as specified on the license was being maintained. Children’s records contained all emergency information specified by regulation. There were no excluded individuals present at this home. All adults who reside or work in the home had a criminal record clearance or exemption as indicated on LIS 531 – Facility Personnel Report Summary. The Licensee and other personnel as specified have completed training on preventative health practices including pediatric CPR and first aid; Expires: 12/30/19. Licensee provided proof of required immunization (Pertussis/Measles). Licensee stated that she plans to take the flu immunization this month. Mandated Reporter Training was completed in October/2018. Licensee understands that she and any assistants must complete this training every two years.
During todays inspection LPAs observed multiple knives in an accessible kitchen drawer and medications on top of a kitchen counter. Kitchen had a baby gate at the time of this inspection and children were not present in the kitchen, however, licensee stated she uses the kitchen area to feed the children regularly. Also observed in the accessible bathroom were two cans of Glade air freshener on the counter and multiple toothpastes in an accessible bathroom drawer.
Report continued on page 809-C

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019
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 3
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, NORMA FAMILY CHILD CARE
FACILITY NUMBER: 543910607
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2019
Section Cited

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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 was not met as evidenced by LPA's observation.
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See page 809 for further details. This poses a potential risk to the health, safety and personal rights of children in care.
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Deficiency cleared today 10/17/19.

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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: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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, NORMA FAMILY CHILD CARE
FACILITY NUMBER: 543910607
VISIT DATE: 10/17/2019
NARRATIVE
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Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services.

LPA provided Licensee with information regarding the California Department of Social Services (CDSS) Provider Information Notices (PINs) communication system; information regarding Safe Sleep Regulations; 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.

Business hours are Monday through Friday 4:30 am to 5:30 pm and other hours as arranged.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found
(see next page): 809-D

Appeal Rights were provided to licensee today.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3