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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011849
Report Date: 03/13/2023
Date Signed: 03/13/2023 01:16:35 PM

Document Has Been Signed on 03/13/2023 01:16 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
198011849
ADMINISTRATOR:GONZALEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 232-4043
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
03/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria Gonzalez, LicenseeTIME COMPLETED:
12:00 PM
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On 3/13/23 Licensing Program Analyst (LPA) Susann Sanchez a conducted a case management visit. LPA met with Licensee husband who stated was the assistant as well did not want to give LPA a tour of the facility and wanted LPA to wait for Licensee Maria Gonzalez.

Licensee greeted LPA and allowed LPA to observe children. LPA observed 2 children and 1 infant present in bedroom 1.

At approximately 10:10am LPA observed a box of medications on the bed on the bedroom. LPA asked Licensee to please remove box of medications. At around 10:35am, LPA asked to tour the facility and observed the same box of medication in the living room couch. Per Licensee, medications are locked in the box. LPA took pictures. Type A was cited.

Also during the tour LPA observe an infant awake in the play yard, LPA observe the same infant in the play yard during first tour at 10:10am. LPA asked Licensee removed infant from play yard around 10:35am. LPA reminded Licensee of the new safe sleep regulations, and gave Licensee an additional copy of PIN 20-24 along with the Individual Infant Sleeping Plan. Type B was cited.

Also during today's inspection, consult was given for the following:
  • updated facility sketch and a copy of the LIC 999- Facility Sketch was given in both English and Spanish.
  • Unusual incident or any changes will be reported to Licensing within 24 hours and an LIC 624B will be submitted within 7 days.
  • Technical Support Program (TSP) was discussed and a referral will be made.
  • POC was discussed from 09/21/22 and was cleared during inspection. Licensee sent proof to wrong number on 09/26/22.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2023
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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Document Has Been Signed on 03/13/2023 01:16 PM - It Cannot Be Edited


Created By: Susann Sanchez On 03/13/2023 at 11:29 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198011849

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/13/2023
Section Cited
CCR
102417(g)(4)

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Operation of a Family Child Care Home: Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children. At 10:10am LPA observed a box of medicationson in
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Per Licensee, will keep medications in the high kitchen cabinet. Citation was fixed during inspection. LPA observed medication in the cabinet at 12:17pm. Technical Support Program (TSP) was discussed and a referral will be made.
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bedroom #1 where children were present. At around 10:35am, LPA asked to tour the facility and observed the same box of medication in the living room couch, accessible to children. LPA took pictures.
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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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/13/2023 01:16 PM - It Cannot Be Edited


Created By: Susann Sanchez On 03/13/2023 at 11:58 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198011849

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2023
Section Cited
CCR
102425(e)

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Infant Safe Sleep: No infant shall be forced to sleep, to stay awake, or to stay in the designated sleeping area: Around At 10:10am. LPA observe an infant awake in the play yard, Around 10:35, LPA observe the same infant awake in the play yard.
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Per Licensee, infant will only be placed in play yard while sleeping. Licensee and LPA reviewed the safe sleep regulations. Technical Support Program (TSP) was discussed and a referral will be made.
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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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2023


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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198011849
VISIT DATE: 03/13/2023
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A copy of this report shall also be posted where the parent/guardian of children enter and exit the facility. Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.
Exit interview conducted with Licensee. Appeal rights were provided.

Exit interview was conducted with Maria Gonzalez, Licensee copy of report was given. Appeal rights were issued and discussed.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023
LIC809 (FAS) - (06/04)
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