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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016194
Report Date: 01/13/2023
Date Signed: 01/13/2023 01:35:27 PM

Document Has Been Signed on 01/13/2023 01:35 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:
198016194
ADMINISTRATOR:GONZALEZ, BERENICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 269-0245
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
01/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Co-Licensee - Citlaly GonzalezTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced required one year inspection to the above facility on 01/13/23. LPA arrived at the facility at 9:55 AM and met with Co-licensee Citlaly Gonzaelz, who guided analyst on a tour of the facility. Also present during this inspection was S2 and S3. Per Licensee, there are 14 children that are currently enrolled. There were 7 children present upon arrival. During inspection, LPA observed that S2 and S3 do not have background clearance. Licensee states that S2 has been residing here since 12/25/22. Licensee also states that S3 does not reside her but comes to the home often because his children reside in the home. LPA advised that a citation under California Code of Regulation (CCR) section 102370(d)(1) will be issued and a civil penalty will be assessed. LPA observed S4 arriving in to the facility at 12:25PM. Per licensee, fingerprints for S4 and S2 were taken 10/2021 and that S4 resides in the home.

This is a one-story home which consists of 2 bedrooms, 1 bathroom, kitchen/dining room, living room, a detached garage, front yard and backyard (fenced). The off limit areas include 2 bedrooms, detached garage, and front yard. The detached garage has been converted into a living space in which S2 resides.

The main care area is located in the living room. LPA observed 3 Graco highchair feeding tables, 3 infant playpens, a wooden storage locker for personal belongings, wall mounted television, child sized tables, child sized chairs, age appropriate toys, and children's art supplies. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the dining area. The kitchen area was observed with locks on the cabinets. No sharp or pointy objects were observed to be accessible in the kitchen area. The licensee states that she provides food for children in care. LPA observed the fire extinguisher to be fully charged, however service tag indicates a service date 11/14/21. LPA advised the licensee that a citation under CCR section 102417(g)(1) will be issued. LPA observed a diaper storage container hanging on the side of the play pen being used by an infant in care. LPA advised licensee that a citation under CCR section 102425(b)(3) will be issued. LPA observed the bathroom designated for children
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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 01/13/2023 01:35 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Randy Derraco On 01/13/2023 at 11:31 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: 198016194

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Under Appeal
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not obtain California clearance or a criminal record exemption prior to individuals residing in the home which poses and immediate Health, safety and/or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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Licensee will have unlceared adults fingerprinted and associated by the plan of correction date. Licensee will advise LPA when clearances are granted.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Trevino Cochran
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023


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Document Has Been Signed on 01/13/2023 01:35 PM - It Cannot Be Edited


Created By: Randy Derraco On 01/13/2023 at 11:31 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: 198016194

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not cover the two barbeque grills located in the backyard play area which poses and potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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Licensee will email a picture to the LPA of the barbeque grills being made inaccessible to children in care.
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not service the fire extinguisher since 11/04/21 which poses and potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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Licensee states she will email LPA a picture of the service tag or purchase receipt of the fire extinguisher.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023


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Document Has Been Signed on 01/13/2023 01:35 PM - It Cannot Be Edited


Created By: Randy Derraco On 01/13/2023 at 11:31 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: 198016194

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not make the cleaning supplies underneath the bathroom sink inaccessible to children in care which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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Licensee will send a picture to LPA on how she will make contents beneath the bathroom sink inacessible.
Type B
Section Cited
CCR
102425(b)(3)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects. (3) There shall be no objects hanging above or attached to the side of the crib.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee had a diaper storage container attached to the side of the play pen which poses and potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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Licensee will remove the storage container from the side of the play pen.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023


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Document Has Been Signed on 01/13/2023 01:35 PM - It Cannot Be Edited


Created By: Randy Derraco On 01/13/2023 at 11:31 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: 198016194

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not document the infant's sleep position every 15 minutes which poses and potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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Licensee will email LPA a copy of completed and updated infant sleep chart.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not complete and include and indicidual Infant Sleeping Plan (LIC 9227) in the infants file which poses and potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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Licensee will email LPA a completed LIC 9227 and maintain the completed form in the infant's file.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023


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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: 198016194
VISIT DATE: 01/13/2023
NARRATIVE
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in care to have an operable toilet, sink and faucet. Cleaning supplies were observed beneath the unlocked sink making it accessible to children in care. LPA advised licensee that a citation under CCR section 102417(g)(4) will be issued. LPA observed the outdoor play area is located in the backyard. LPA observed a tether ball pole, a playing structure, outdoor play equipment and additional age appropriate toys in the backyard play area. Perimeter fencing and adequate shade was also observed in the backyard play area. LPA observed two uncovered barbeque grills in the backyard play area. LPA advised licensee that a citation under CCR section 102417(g) will be issued. LPA observed that there is a wall heater in the living room that is screened. Smoke and carbon monoxide detectors were tested and are operable. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. Licensee states that there are no firearms stored in the home. No bodies of water were observed in the back yard play area. A pet dog was observed in the off-limits area of the backyard.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety,
comfort, and cleanliness. There is telephone service via a landline . Per Licensee, the home is equipped with wall mounted air conditioning units. Day care area was observed with safe toys, play equipment and materials.

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.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 06/2024 LPA observed that the Licensee has proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. File review was observed to have proper mandated immunization records. Children’s records were reviewed, including emergency


(page 2 of 3)
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198016194
VISIT DATE: 01/13/2023
NARRATIVE
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information. LPA observed that the infant's file did not have LIC 9227 - Individual Infant Sleeping Plan completed. LPA advised licensee that a citation under CCR section 102425(c) will be issued. LPA observed that the infant in care did not have a current infant sleep chart available. LPA also observed infant napping without having her sleep position documented. LPA advised licensee that a citation under CCR section 102425(j)(1) will be issued. A current children’s roster was available for review.

Incidental Medical Services (IMS):
IMS was discussed with licensee. Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.cdss.ca.gov.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

LPA R. Derraco informed licensee Citlaly Gonzalez that this report dated 01/13/23 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk to the health, safety, or personal rights of children in care. Also, LPA R. Derraco informed the licensee Citlaly Gonzalez to provide a copy of this licensing report dated 01/13/22 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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, appeal rights providedand report was reviewed with the licensee Citlaly Gonzalez. (page 3 of 3)

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
LIC809 (FAS) - (06/04)
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