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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021105
Report Date: 10/08/2024
Date Signed: 10/14/2024 09:38:18 AM

Document Has Been Signed on 10/14/2024 09:38 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
198021105
ADMINISTRATOR/
DIRECTOR:		GONZALEZ, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 652-9723
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 5DATE:
10/08/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Licensee Elizabeth GonzalezTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 10/08/24 at 1:00pm, Licensing Program Analysts (LPA) Stephanie Li conducted an unannounced annual inspection to the above facility. A risk assessment was conducted upon entry. LPA met with Licensee Elizabeth Gonzalez, who led LPA on a tour of the facility. There were 5 children and 2 adults present upon arrival. Also present was licensee’s nephew. LPA advised that all individuals in the home that are above 18 years old needs to get their fingerprint livescan completed. Per Licensee, there is currently 10 children enrolled. A current children’s roster was available for review.

This is a one story home which consists of 3 bedrooms, 1 restrooms, entry hallway, living room, dining room, kitchen, daycare room, 2 back yards (right: on limits, left: off limits), garage and (fenced) pool. The children have access to day care room, right back yard, dining room, entry hallway, and the restroom located in the hallway. The licensee states that 3 adults and 1 child currently live in the home. LPA observed a large German Shepard in the left yard that is off limits. LPA observed dogs temperament at the time, to be friendly, curious and playful. Per Licensee there are no firearms or weapons stored in the home. Bodies of water was observed in the left back yard. An in ground fenced pool was observed in the left side of the off limits back yard. The pool is gated with a fence that has a self latching gate. Sliding glass door leading to yard also has a door alarm and rings when sliding door is opened. LPA observed that licensee keeps sliding door locked.

Per licensee, areas off limits to children and parents include 3 bedrooms, living room, kitchen, left side back yard, and garage. LPA toured all areas used by children during this visit. LPA reminded licensee to keep all bedroom doors closed and make inaccessible during operating hours as bedrooms are near children’s restroom.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198021105
VISIT DATE: 10/08/2024
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All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness.

The following was observed and reviewed during this inspection. Cleaning compounds, and medications were observed to be inaccessible to children. Per licensee, there are no poisons kept in the home. The restroom that children use was observed to be safe and sanitary. There is telephone service via cellphone that stays at the facility during operation hours. The home is observed to be clean and orderly with central air and heat. There are toys available for children. Napping play pens were observed in the child care room. There are first aid supplies available.

LPA observed the following required posted documentation in the main entry way of the facility: Facility License, (LIC) 9148- Earthquake Preparedness form, and LIC 610- Facility Disaster Plan, Publication (PUB) 394- Notification of Parent Rights and Licensing Form LIC 9040- Facility Roster. PUB269 Car seat posting was missing. LPA printed and provided for licensee.

At 1:30pm, LPA observed the required 2A 10BC fire extinguisher which was last serviced per service tag on 3/10/24. LPA advised licensee that per State Fire Marshall standards that fire extinguishers shall be serviced annually and if self purchasing to keep the receipt with the fire extinguisher. Smoke and carbon monoxide detectors were tested and are operable. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill was conducted in 9/30/24. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted on the parent board in the classroom.

Currently, children are using the right side yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed the outdoor yard to have appropriate toys and other materials for children to use. LPA did not observe any objects that can pose a danger to children in the outdoor yard. The licensee is observed to be operating within the license capacity limitations.
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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198021105
VISIT DATE: 10/08/2024
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At 2:00 pm, children and adult records were reviewed, including emergency information. The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. However, CPR and First aid expired on 9/10/22. LPA observed Licensee to call their CPR trainer and set up an appointment for a new training and certificate. A Type B citation is being issued for expired CPR. Licensee has completed the Mandated Reporter AB 1207 Training Certificate expiration date 4/17/25. LPA observed that assistant does not have mandated reporter training certificate. LPA shared that mandated reporter is available in Spanish now. A type B citation is being issued. 2 children’s files were missing signed medical consent from parent. LPA printed medical consent copies and gave to licensee. Per licensee, she will have parents fill it out and send a picture to LPA this Friday 10/11/24. For the health and safety of all children in care, all deficiencies must be cleared.

Licensee stated IMS is not being provided at this time. 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/.

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

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198021105
VISIT DATE: 10/08/2024
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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. LPA gave licensee a blank livescan request form for nephew and advised that he completes his livescan fingerprints.

Megan’s Law - Family Child Care Homes During the exit interview, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov



MyChildCarePlan.org – Centers and Family Child Care Homes Licensee 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

Based on Licensing staff observations and records review, the following deficiencies listed on the attached LIC 809D (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 and safety.


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

Exit interview conducted and report was reviewed with Licensee Elizabeth Gonzalez.



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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/14/2024 09:38 AM - It Cannot Be Edited


Created By: Stephanie Li On 10/08/2024 at 02:36 PM
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 198021105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 2 adults caring for children did not have mandated reporter training certificate, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/11/2024
Plan of Correction
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Per licensee, assistant (husband) will complete mandated reporter training and will email certificate to LPA by 10/11/24.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as licensee's cpr and first aid was expired in September 2022 and licensee did not renew certificate, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/11/2024
Plan of Correction
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LIicensee has enrolled for CPR and first aid training to complete by tomorrow 10/9/24 and send certificate by 10/11/24.
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:Christina Gabelman
LICENSING EVALUATOR NAME:Stephanie Li
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024


LIC809 (FAS) - (06/04)
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