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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283009948
Report Date: 08/22/2022
Date Signed: 08/22/2022 01:42:41 PM

Document Has Been Signed on 08/22/2022 01:42 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:GONZALEZ-SANCHEZ, CYNTHIA & BUENROSTRO, JANETTEFACILITY NUMBER:
283009948
ADMINISTRATOR:GONZALEZ C & BUENROSTRO JFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 210-7299
CITY:NAPASTATE: CAZIP CODE:
94559
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
08/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Cynthia Gonzales- Sanchez, LicenseeTIME COMPLETED:
01:55 PM
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An annual required inspection was made to the facility by Licensing Program Analyst (LPA), Kevin O'Connell.
A review of staff records on 8/22/2022 indicates that all other facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, 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. There is currently one adult living in the home.
During today’s inspection the home and grounds were toured.
The licensee and two assistants were supervising 3 infants and 4 preschool children. The facility’s operating hours are 07:45am to 05:45pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified.
The off-limits areas of the home were made inaccessible by a baby gate and door handle covers.
The backyard is used for outdoor play and is completely fenced.
The home was observed to be clean and orderly, and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home.
The licensee’s Pediatric CPR and First Aid certifications were current. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children.
The licensee stated there are no firearms or ammunition stored on the premises and none were observed. The LPA observed a working smoke detector & carbon monoxide detector and fire extinguisher, rated at least 2A10BC in the home. The fireplace was barricaded with a baby-gate.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Kevin O'Connell
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2022
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 08/22/2022 01:42 PM - It Cannot Be Edited


Created By: Kevin O'Connell On 08/22/2022 at 01:13 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: GONZALEZ-SANCHEZ, CYNTHIA & BUENROSTRO, JANETTE
FACILITY NUMBER: 283009948

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2022

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 interview and record review, the licensee did not comply with the section cited above in which the Licensee did not posses a current Mandated Reported certificate and admitted that it had not been updated which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/05/2022
Plan of Correction
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Licensee stated that she will complete the AB1207 Childcare Mandated Reporter Training and send a copy of the certificate to CCL by 9/5/22.
kevin.oconnel@dss.ca.gov
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:Leslie Lepori
LICENSING EVALUATOR NAME:Kevin O'Connell
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2022


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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: GONZALEZ-SANCHEZ, CYNTHIA & BUENROSTRO, JANETTE
FACILITY NUMBER: 283009948
VISIT DATE: 08/22/2022
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Poisons are "key locked" in an outdoor shed. The Licensee states that there are no pools, spas, fountains or water features and none were observed.
Seven children's records were reviewed at 12:30pm during today's inspection. Three staff records were reviewed at 12:45pm.
LPA reviewed infant safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep web page 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.
Incidental Medical Services (IMS) policy was discussed. Licensee is not providing any IMS at this time. 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: http://www.ada.gov/childqanda.htm

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Cynthia Gonzalez- Sanchez. Please see LIC 809d for Title 22 violation cited today.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Kevin O'Connell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022
LIC809 (FAS) - (06/04)
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