543911261-6-16-2021-04-CC-JTHN-C42QEY-20210616120706

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543911261
Report Date: 06/16/2021
Date Signed: 06/16/2021 12:07:10 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, YULIANA FAMILY CHILD CARE		FACILITY NUMBER:	543911261
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	06/16/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Yuliana Gonzalez		TIME COMPLETED:	12:05 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

On 6/16/21 Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced Annual Required Inspection and was met by Licensee Yuliana Gonzalez. Also present was Staff #1 (S1). Days and hours of operation are Monday through Friday from 7:00AM – 5:30PM.

LPA toured the home inside and outside and a census was taken. Current facility sketch was reviewed and Licensee confirmed that the kitchen, bathroom and living room, and day-care room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of baby gate. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Stairs are fenced or barricaded when children under age five years old are present. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (559) 859-0075.

There are currently no infants in care. LPA discussed Safe Sleep Regulations with Licensee. Licensee agreed to comply with current regulatory requirements should care of infants take place within the home.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. The backyard is an off-limit, inaccessible area of the home. Outdoor play takes place at a nearby park. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and completed emergency information was observed. Licensee’s Mandated Reporter Training was completed on 3/14/20; S1’s Mandated Reporter Training was completed on 4/5/20. Licensee & S1’s pediatric CPR/First Aid expires on 4/04/22 (see next page, LIC809-C).

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

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, YULIANA FAMILY CHILD CARE	FACILITY NUMBER: 543911261
	VISIT DATE: 06/16/2021

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

A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

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. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

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

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and 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: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2