197700351-3-15-2023-12-CC-JDOY-CPXMT2-20230315095249

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700351
Report Date: 03/15/2023
Date Signed: 03/15/2023 09:53:34 AM

Document Has Been Signed on 03/15/2023 09:53 AM - 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	GONZALEZ FAMILY CHILD CARE		FACILITY NUMBER:	197700351
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	03/15/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Hilda Gonzalez		TIME COMPLETED:	10:07 AM

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On 03/15/2023, Licensing Program Analyst (LPA) Justin Dorsey conducted a Capacity Increase Pre-Licensing inspection with Licensee, Hilda Gonzalez to ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety requirements. During the visit Assistant #1 was present to aid LPA Dorsey with the inspection. The Licensee is requesting to provide care for a Large family childcare home for the capacity of 14 children. Currently, there are 3 adults (including Licensee) living in the home. LPA toured the home indoor and out to ensure it meets FCCH requirements. The Licensee is requesting the days and hours of operation to be Monday through Saturday 6:00am - 6:00pm.

The home is described as follows: This is a one story 3 bedroom, 2 bathroom home with kitchen, dining room, living room, family room, laundry room and garage. There is no pool on the premises.

Indoor: Main area: Main care is provided in the family room. There are gates present to ensure children don't access any other areas of the home other than the main care area and children's restroom. The only time children access the living room is to access the backyard.
Bathroom #1: Children will use the bathroom #1 near the family room. Bathroom #1 was toured, and inspected, toilets are in operable condition. Toilet and faucets are clean, safe, and operable; bathtub and shower area free of hazard. There are no medications or items stored in the medicine cabinet.

Kitchen: The kitchen is made inaccessible to children by gate. All lower kitchen cabinets and drawers are locked. Sharp utensils, cleaning supplies, medicines; drawers and cabinets with plastic bags, and sharp things or small things children can swallow; are inaccessible to children. The refrigerator dishwasher, stove, microwave, etc., are clean. The kitchen was clean, orderly, and free of hazardous items. Medications are stored locked high in a kitchen cabinet, knives are stored on top of the refrigerator and cleaning supplies are locked under the sink.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 197700351
	VISIT DATE: 03/15/2023

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Outside: The backyard was inspected. The backyard is completely fenced, children will play outside only in the backyard. There is concrete and grass areas for children to play. LPA observed toys and play equipment in good condition. In the homes backyard there are two off-limit areas to the left and right side of the backyard. These areas are made off limits by gate.

Advisory/Other: First Aid kit was readily available. The licensees CPR/First Aid expires on 04/06/23. Mandated Reporter was completed 08/24/23. Children nap on mats and in cribs in the family room. During the visit LPA Dorsey observed the homes carbon monoxide detector, smoke detector and 2A10BC fire extinguisher were in operable condition.

Documents discussed: IMS Reference Guide, Personnel Records 102416.1, Safe Sleep PIN 20-24-CCP, LIC 9227, Infant Safe Sleep Log and Large Family Child Capacity Worksheet.

Assistant #1 was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Assistant #1 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.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted. Report and Appeal rights were reviewed with Assistant #1.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC809 (FAS) - (06/04)

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