198400544-4-11-2022-54-CC-DCHS-CDDQ35-20220411114811

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400544
Report Date: 04/11/2022
Date Signed: 04/11/2022 04:17:20 PM

Document Has Been Signed on 04/11/2022 04:17 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 & GONZALEZ FAMILY CHILD CARE		FACILITY NUMBER:	198400544
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	04/11/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Yesenia and Ma Rosalba Gonzalez, applicants		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Dayna Chambers conducted a pre-licensing inspection on April 11, 2022 at 9:30AM. LPA met with applicant Yesenia Gonzalez and Co-applicant Ma Rosalba Gonzalez, who guided analyst on a tour of the facility. During the inspection individuals residing in the home were discussed and noted. The applicant is requesting a small family childcare home license. Per applicant, operation hours will be Monday to Friday, 6:00AM to 6:30PM. Applicant states that they will care for children 3 months to 13 years of age. Entrance Checklist was provided to the applicant upon arrival. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one-story house. The home has 3 bedrooms, 2 full bathrooms and 1 ½ bath, dining room, living room, kitchen and detached garage. Off-limit areas include: Bedroom #1 and Bedroom #2, the hallway bathroom, kitchen, and the second half of backyard. Per applicant, the children will use the restroom located in bedroom #3. Children will use the dining room, living room, and bedroom #3. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating via central heat and air. During the inspection, LPA advised that the cellphone must always remain at the facility. Applicant provided co-applicants cell number during the inspection. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The applicant states that there are no poisons on the premises. The applicant was advised that any poisons must be locked with a key or combination lock. The applicant understands that licensing staff may have access to off-limit areas during inspection visits if necessary.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

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 3

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 & GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 198400544
	VISIT DATE: 04/11/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

There is a large backyard that is split into two sections. Section one is for the children’s play area and is fenced. Section two of the back yard is locked and fenced and inaccessible to children. The second half of the backyard has a trampoline which is off-limits and inaccessible to children. LPA obtained a Declaration (LIC855) from applicant which explains the outdoor activity plan and states that children will always be physically and visually supervised and the trampoline is always inaccessible from children.

Per applicant, there are two dogs, three birds, two firearms which are inaccessible to the children. There are no bodies of water in the backyard.

The valve on the 2A10BC fire extinguisher indicates fully charged, a receipt of purchase dated 08/16/2021 was provided. LPA advised that the receipt be attached to the fire extinguisher. When inspecting the home, LPA did observe a smoke detector. A carbon monoxide detector was observed in the hallway and living room area and was tested to ensure that it is operable. Applicant stated that children will play in the living room, dining room, and bedroom #3. There are toys available for children.

The applicant states that they will provide food for children in care. If food is not provided and food is brought from the children’s homes; container shall be labeled with child’s name and properly stored or refrigerated.

The applicant has completed the required Health and Safety Training, Nutrition & Lead Training and Pediatric First Aid and CPR which expires for applicant Yesenia: 07/24/2023 and Ma Rosalba 07/24/2023. There are first aid supplies available.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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. Applicant was reminded of all the terms and conditions noted on the LIC 279 – Application of a Family Child Care Home that applicant signed and agreed to.

Applicant states that they will care for infants. LPA advised the applicant to sleep infants where they can

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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 & GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 198400544
	VISIT DATE: 04/11/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

always be directly supervised and advised against sleeping infants in a separate room. The applicant states the following is a supervision plan for infants: Applicant states that infants will sleep in the living room where they will be providing supervision. LPA provided the applicant with a copy PIN 20-24-CCP Safe Sleep Awareness Campaign which has links to information on Safe Sleep and SIDS. LPA also provided the LIC 9227 to Applicant. LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] 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.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:

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: http://www.ada.gov/childqanda.htm

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
LPA reviewed with applicant the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Exit interview conducted and report was reviewed with the applicant, Yesenia Gonzalez and Ma Rosalba Gonzalez.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3