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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334800563
Report Date: 12/18/2024
Date Signed: 12/18/2024 11:08:38 AM

Document Has Been Signed on 12/18/2024 11:08 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GODOY FAMILY CHILD CAREFACILITY NUMBER:
334800563
ADMINISTRATOR/
DIRECTOR:		SANDRA GODOYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 685-6797
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 0DATE:
12/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:12 AM
MET WITH:Licensee Sandra Godoy and Jose GodoyTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On 12/18/2024 at 8:12 AM Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct an annual inspection. LPA was greeted by Licensees Sandra and Jose Godoy. The LPA was granted entry to tour the facility inside and out. The LPA reviewed records and observed and/or discussed the following: The licensees updated the LIC279 Application, LIC279B, LIC999A facility sketch for off-limit areas and the LIC610A Emergency disaster forms. The licensee is placing the outdoor area temporarily off limits to landscape and will notify the department prior to making the back yard accessible to children.

Normal days and hours of operation: 6:00 AM to 6:00 PM
OFF-LIMIT AREAS INCLUDE: The Garage, Living Room, Den, Master Bed RM 1/Bath 1; Bed RMs 2, 3, 4; backyard temporarily off-limit.

The inspection consisted of reviews of the following domain: Physical Plant, Care and Supervision, Records, Facility Administration, Staffing Ratio and Capacity, Personal Rights.

The inspection found the facility to be in compliance in these domains, except as noted on the LIC809D.
· The facility is operating within the licensed capacity and appropriate ratios. LPA took a census of 0 children in care.
· The Licensee is present in the home and has ensured that children in care are supervised.
· When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children.
· A working telephone is present.
· A fully charged fire extinguisher (2A:10BC) was observed and tagged by the fire department and needle in the green. A smoke detector and carbon monoxide detector were present and tested by the licensee during this inspection.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GODOY FAMILY CHILD CARE
FACILITY NUMBER: 334800563
VISIT DATE: 12/18/2024
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· All hazardous items ARE NOT inaccessible, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children. The LPA observed medications/supplements in an upper kitchen cabinet and several kitchen knives in a lower kitchen drawer. The LPA observed Clorox clean-up wipes, supplement powder mix, air fresheners and dog clean up fresheners on the kitchen counter along with cleaning compounds unlocked under the kitchen sink. LPA observed perfumes, nail polish remover on the restroom counter, in the medicine cabinet and treatment shampoos, razor in the shower accessible in the restroom designated for daycare. No children were present at the time of the inspection. The licensee removed the items in the presence of the LPA and relocated the items to the garage to make inaccessible until the licensee can install locks and latches for regulatory storage.
· Storage of poisons are NOT inaccessible to children and are NOT locked as stated above.
· No stairs, this a single-story home.
· The fireplace is properly screened on today’s date.
· No guns or weapons present as stated by the Licensees Sandra and Jose. Licensees understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· Home is clean and orderly, with heating and ventilation for safety and comfort.
· Clean, Safe and age-appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas are fenced and/ or appropriate supervision is present.
· Verification of control of property on file by rental agreement.
· Property owner/landlord notification and consent on file by:
· Pediatric CPR and First Aid training on 02/11/2023; Card expires on 02/2025 for both licensees.
· Health & Safety Certificate - completed on 10/23/2010; No Nutrition or Lead components.
· Mandated reporter General: 03/24/2023; AB 1207 Child Care Expires: 03/2025
· Fire clearance: 01/21/1997
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 11/07/2024 at 6:50 AM, with 3 children present.
· There are no bodies of water on today’s date. Licensees Sandra and Jose Godoy, understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GODOY FAMILY CHILD CARE
FACILITY NUMBER: 334800563
VISIT DATE: 12/18/2024
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The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Children’s files are complete on today's date.
· Staff’s files are complete. Per licensees, they do not have any other staff employed at this time.
· A review of staff records on 12/18/2024 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information, see PIN 22-02-CCP. 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

Licensees Sandra and Jose, were 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 S. Brewer, discussed the safe sleep regulations with licensees Sandra G. and Jose G. 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. The licensee stated they are no longer enrolling infants or toddlers under Two years of age.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GODOY FAMILY CHILD CARE
FACILITY NUMBER: 334800563
VISIT DATE: 12/18/2024
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LPA also informed licensees Sandra G. and Jose G., 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.

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.

A deficiency was issued on today’s date for a Type B violation.

No civil penalties issued on today’s date.

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

Exit interview conducted and report was reviewed with the licensees Sandra Godoy and Jose Godoy.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/18/2024 11:08 AM - It Cannot Be Edited


Created By: Susan Brewer On 12/18/2024 at 10:34 AM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GODOY FAMILY CHILD CARE
FACILITY NUMBER: 334800563

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in medications/supplements, several kitchen knives, Clorox clean-up wipes, supplement powder mix, air fresheners and dog clean up/freshener and cleaning compounds were accessible in the kitchen drawers/cabinets and on kitchen counter, perfumes, nail polish remover, treatment shampoos and razor shower were accessible in the designated for daycare which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/23/2024
Plan of Correction
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The licensee agrees to submit a written statement to ensure the home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. The licensee agrees to submit proof of corrections by photo through fax, mail or e-mail on or before 12/23/2024.
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:Ana Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2024


LIC809 (FAS) - (06/04)
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