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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409291
Report Date: 06/05/2024
Date Signed: 06/05/2024 02:12:03 PM

Document Has Been Signed on 06/05/2024 02:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:PINZON, GLORIAFACILITY NUMBER:
073409291
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
06/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:55 AM
MET WITH:Gloria PinzonTIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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On June 5, 2024 Licensing Program Analyst (LPA) Indira Loza met with Licensee Gloria Pinzon for an unannounced Annual/Random inspection. LPA also inspected the home for a capacity increase. Present during today's inspection were the Licensee, the Licensee's Husband/Assistant Carlos Cabrera, 3 preschoolers, and one infant. Licensee lives in the home with her husband, their two (2) minor children, brother-in-law, and 3 chihuahuas housed in the off limit area of the backyard. The facility operates from 7am-11:40pm, Monday – Friday.

ON LIMITS AREA: The first bedroom on the left of the hallway, bathroom on the right of the hallway, living room, and the side outdoor patio.
OFF LIMITS AREA: The two bedrooms at the end of the hallway, kitchen, and entire backyard.
ISOLATION AREA: The first bedroom to the left of the hallway

The facility is single story home consisting of a kitchen, living room, three bedrooms, one bathroom, garage, backyard and side yard. The inside of the home is observed to be neat, clean with ample age-appropriate materials for the children. All toxins and cleaning products were observed to be in inaccessible areas. Licensee stated she provides all food for the children which was observed to be properly maintained and stored. Licensee uses child sized table for eating that were observed to be clean and well maintained. LPA observed cribs for the infants and was observed to be well maintained. All off limit areas are made inaccessible with closed/and or locked doors, and/or visual supervision. Per Licensee there are no firearms in the home.

The home has one fully charged 2A10BC fire extinguisher in the living room. There is one working combined smoke detector and carbon monoxide in the living room. The home is equipped with central heat


and air for proper ventilation. The fireplace in the living room is blocked with a toy storage she, making it inaccessible to the children in care. The side yard is fully fenced and is utilized for outdoor play. LPA observed ample materials for the children in care. There were no harmful bodies of water in or around the home. The Licensee stated she currently has Liability Insurance.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PINZON, GLORIA
FACILITY NUMBER: 073409291
VISIT DATE: 06/05/2024
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The facility is operating within its licensed capacity and is in ratio. Licensee’s EMSA approved Pediatric CPR & First Aid has been completed and expires August 12, 2025. Licensee’s Mandated Reporter has been completed and expires December 15, 2025. Fire/disaster drills have been conducted and recorded with the last drill logged December 19, 2023. All required forms are posted and visible for public view in the living room. LPA reviewed one two staff files and four children files.

Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's parents, and to the Department within 24 hours by phone. Within seven (7) days from the incident, Licensee’s must submit the Unusual Incident/Injury form (LIC 624B) to the Department. Licensee was reminded that any structural changes or additions to the home must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting https://mandatedreporterca.com/. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.



Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must
obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PINZON, GLORIA
FACILITY NUMBER: 073409291
VISIT DATE: 06/05/2024
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(R&Rs) throughout California. During the exit interview, Licensee Gloria Pinzon, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

The Contra Costa Fire Protection Department granted the facility a fire clearance on 5/30/2024. An increase capacity for 14 children is being approved today, effective June 6, 2024.

There were deficiencies cited during today's visit

Exit interview conducted
A notice of site visit was given and must remain posted for 30 days.
Report and Appeal Rights was reviewed with the Licensee Gloria Pinzon.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC809 (FAS) - (06/04)
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