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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623984
Report Date: 08/10/2022
Date Signed: 08/10/2022 12:30:16 PM

Document Has Been Signed on 08/10/2022 12:30 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:GONZALEZ, MINERVAFACILITY NUMBER:
313623984
ADMINISTRATOR:MENDOZA, MELISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 219-4048
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
08/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Minerva GonzalezTIME COMPLETED:
12:45 PM
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On August 10th, 2022, at 11:00 am, Licensing Program Analysts (LPAs) Jeremey McClain and Mandie Goodwin met with Licensee Minerva Gonzalez for an unannounced annual inspection.

LPAs observed a census of 12 preschool aged children. Licensee was assisted by Darden Dickerson during today’s inspection. Licensee stated there aren’t new residents in the home. All adult residents have criminal record clearances. Licensee, Minerva Gonzalez 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.

LPA toured areas of the home accessible to the children. The off-limit areas of the home were inaccessible.

LPA observed current CPR/First Aid scheduled for 08/13/2022. LPA advised Licensee to send a copy of certification via email once the class has been completed. LPA observed the following posted: a license, a Parents' Rights Poster and an Emergency Disaster Plan. LPA provided Licensee with website: http://childcare.mandatedreporterca.com/ and reminded the licensee that the training must be completed once every two years.
LPA reviewed children's records for completeness, as well as the client roster. LPA observed records of immunizations for MMR, Pertussis, and influenza.

During the interior and exterior inspection:
LPA observed that hazardous items (detergents, cleaning compounds, medication, sharp utensils, and other items that could pose a danger to children in care) are properly stored out of children's reach.
LPA observed a fireplace that was properly screened. LPA observed a working telephone in the home. Licensee stated that there are no weapons in the home.
LPA observed a fire extinguisher which was last serviced on within the last year. Carbon monoxide and smoke detectors were tested and observed to be functional.
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SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: GONZALEZ, MINERVA
FACILITY NUMBER: 313623984
VISIT DATE: 08/10/2022
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LPA observed fire drills documented on a calendar, indicating that the licensee is conducting disaster drills at least once every 6 months.

Equipment and furnishings in areas where children are active appeared to be safe and in working order. Appropriate nap equipment for infants was observed. Licensee has conducted and documented 15-minute sleep checks for infants.

LPA did not observe any standing bodies of water during today’s inspection.

This facility currently provides Incidental Medical Services (IMS) and has a plan of operation in place. 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.

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.

No deficiencies were observed during today’s inspection.



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SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
LIC809 (FAS) - (06/04)
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