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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004921
Report Date: 09/05/2025
Date Signed: 09/08/2025 10:19:09 AM

Document Has Been Signed on 09/08/2025 10:19 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
198004921
ADMINISTRATOR/
DIRECTOR:		GONZALEZ, DORAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 428-6418
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
09/05/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:35 PM
MET WITH:Licensee- Dora GonzalezTIME VISIT/
INSPECTION COMPLETED:
02:48 PM
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Amended report as of 9/8/25. Line 1 Pg1 On September 5, 2025, at 12:35p.m., Licensing Program Analyst (LPA) Keneisha Dunlap arrived at the above facility for the purpose of an unannounced Annual Inspection. LPA Dunlap announced the purpose of the visit and was granted entry into the facility by Licensee- Dora Gonzalez. There are 14 children enrolled, and 12 children present at the time of inspection. The hours of operation are Monday- Friday from 6:00a.m.-6:00p.m.

This is a one-story home which consists of three bedrooms, two bathrooms, kitchen/dining room, living room, car port, front yard and fenced backyard. The off limit areas include all three bedrooms, and one bathroom.

The License, Earthquake Disaster Checklist (LIC9148), Disaster Plan (LIC610A), and PUB 394 (Parent's Rights) were all observed to be posted. The Licensee maintains a current LIC 9040 (facility roster). The most recent disaster drill was conducted on August 8, 2025, and documented in the disaster drill log.

Living Room (Main Care Area): This area has tile floors with area rug, sectional couch, mounted TV, four playpens, four highchairs, cubbies for children’s belongings. The children nap here also. LPA Dunlap observed all furnishings, equipment, and materials were in good condition.

Kitchen: LPA Dunlap observed the kitchen to have baby gate, and the knives are stored under the sink, and all cabinets and drawers have key locks making it inaccessible to children in care.

Outdoor Play Area (Back Yard): The front yard features a small artificial grass area, age-appropriate toys, tables, balls, a small slide structure, tricycles, and mobile cars. LPA Dunlap observed all furnishings, equipment, and materials were in good condition, free of sharp, loose, or pointed parts.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2025
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 7
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198004921
VISIT DATE: 09/05/2025
NARRATIVE
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Second Bedroom: This area has tile floors with area rug, two playpens, soft furnishings, toys, and a mounted TV. The children nap here also. LPA Dunlap observed all furnishings, equipment, and materials were in good condition, free of sharp, loose, or pointed parts.

Enclosed Patio: This area has tile floors and features soft furnishings, and designated areas for dramatic play, science area, math area, a library, language arts, manipulative items, age-appropriate toys, changing station, and age-appropriate chairs & tables. The mats are stored in this area. LPA Dunlap observed all furnishings, equipment, and materials were in good condition, free of sharp, loose, or pointed parts.

Bathroom: The bathroom features an operable toilet, and sink. There are cleaning items and personal hygiene items stored in cabinets in this area with key locks making it inaccessible to children in care.

The home is ventilated by an HVAC system, and ceiling fans.

An operable fire system with a pull-down alarm and siren located in the living room area.

LPA Dunlap observed 2A 10BC fire extinguisher with a service tag dated February 26, 2025, hung in the kitchen area.

LPA Dunlap observed an operable carbon monoxide detector.

LPA Dunlap observed an operable smoke detector.

The Licensee confirmed the following:

Meals are provided for children.

A cell phone is used for communication.

The facility does not currently administer medication.

Sick children are isolated in the living room.

There are no firearms in the home.

There are no smokers in the home.

Transportation is not provided for children. Page 2 of 5

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198004921
VISIT DATE: 09/05/2025
NARRATIVE
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A first aid kit is available.

There are no large bodies of water on the premises.

There is one pet on the premises.

Staff Files



Staff #1's file contains all required licensing documents and their immunization record.

CPR certification expires on March 22, 2026.

Mandated Reporter training expires on October 10, 2026.

Staff #2's file contains all required licensing documents and their immunization record.

CPR certification expires on December 12, 2026.

Mandated Reporter training expires on October 10, 2026.

Preventative Health & Safety Certificate.

Staff #3's file contains all required licensing documents and their immunization record.

CPR certification expires on November 25, 2026.

Mandated Reporter training expires on October 10, 2026.

Staff #4's file contains all required licensing documents and their immunization record.

CPR certification expires December 12, 2026.

Mandated Reporter training expires on October 10, 2026.

Preventative Health & Safety Certificate.

At 1:45 PM, LPA Dunlap observed that four out of four staff members did not have their influenza vaccination or declination in their file. This presents a potential health and safety risk to children. A Technical Violation will be issued today.


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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198004921
VISIT DATE: 09/05/2025
NARRATIVE
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Children Files

Child #1's file contains all required licensing forms, and their immunization record.

Children Files

Child #2's file contains all required licensing forms, and their immunization record.

Children Files

Child #3's file contains all required licensing forms, and their immunization record. Current Safe Sleep logs were reviewed.

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

Licensee- Dora Gonzalez 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.

LPA discussed the safe sleep regulations with Licensee- Dora Gonzalez and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed Licensee- Dora Gonzalez 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.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198004921
VISIT DATE: 09/05/2025
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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-carecenters/.

Licensee- Dora Gonzalez was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee- Dora Gonzalez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

1 Technical Violation issued today.

Appeal rights explained and given to Licensee- Dora Gonzalez.

Exit interview conducted and report was reviewed with the Licensee- Dora Gonzalez.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC809 (FAS) - (06/04)
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