304313838-8-6-2024-06-CC-NKTN-D7VURM-20240806154857

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313838
Report Date: 08/06/2024
Date Signed: 08/06/2024 03:49:01 PM

Document Has Been Signed on 08/06/2024 03:49 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	GONGORA VALENCIA, MARIA DEL MAR		FACILITY NUMBER:	304313838
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 5	DATE:	08/06/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:00 PM
MET WITH:	Maria Gongora, Licensee		TIME VISIT/ INSPECTION COMPLETED:	04:00 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) Tran conducted an announced, Case management inspection due to a request being submitted by Licensee to increase capacity from a Small Family Child Care home to a large family child care home. The LPA met with Licensee, who provided a tour of the home. A review of the Facility Personnel Report Summary indicates 3 adult(s) live in the home. The adult resident(s) received caregiver background check clearances or exemptions as required by the Department. Per the licensee, there is 1 minor living in the home. All areas on the Facility Sketch LIC 999 were inspected, including but not limited to, off-limits areas. Off limits areas are made inaccessible by means of doors. The childcare area consists of the living room, which is accessed through the front door and the bedroom on the left of the hallway, where the children nap. The children walk through the hallway to the bathroom. Licensee stated the children's primary area is the living room. There is at least one working carbon monoxide, smoke detector, fire extinguisher and fire alarm system in the home that meet statutory and State Fire Marshall standards. Facility received Fire clearance to provide care for up to 14 children on 07/11/2024. A records review indicates the licensee completed the required Health and Safety Training with Nutrition and Lead Poisoning components. The licensee and assistant has a current Pediatric First Aid and CPR certification that expires on 08/2024. Licensee and assistant have current Mandated reporter training on file. In the absence of the licensee, a qualified adult must be present to supervise the children—a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification, TB clearance and immunization, and valid criminal record clearance that is associated with the licensed facility. (Continue next page)

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GONGORA VALENCIA, MARIA DEL MAR	FACILITY NUMBER: 304313838
	VISIT DATE: 08/06/2024

NARRATIVE

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(Page 2 of Report)

The Incidental Medical Services (IMS) policy was discussed. A link to PIN 22-02-CCP was provided here: PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child. When IMS are provided, a Plan for Providing IMS must be submitted to the Department. The applicant plans to store the medication in the kitchen, in a cabinet above the countertop, or in the refrigerator if needed.
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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA discussed the safe sleep regulations with the applicant 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. LPAs also informed the applicant 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.

Capacity Handouts for a Small Family Child Care Home and Large Family Child Care Home were provided.

The facility was in compliance with Title 22 Regulations at the time of inspection. In the event additional requirements are needed, the applicant will be notified. An update license will be issued once all requirements are met.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Maria Gongora.
(End of Report)

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2