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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846206
Report Date: 01/18/2024
Date Signed: 01/18/2024 04:30:49 PM

Document Has Been Signed on 01/18/2024 04:30 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
334846206
ADMINISTRATOR:GONZALEZ, SUSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 333-5606
CITY:EASTVALESTATE: CAZIP CODE:
91752
CAPACITY: 14TOTAL ENROLLED CHILDREN: 18CENSUS: 9DATE:
01/18/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Susan GonzlezTIME COMPLETED:
04:45 PM
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On 01/18/2024 at 8:25 AM Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct an annual inspection. LPA was greeted by Licensee Susana Gonzalez and granted entry to tour the facility inside and out. LPA reviewed records and observed and/or discussed the following: The licensee and 4 adults present at the home. The licensee agrees to update the LIC279 Application form, the LIC610 Emergency Disaster plan, the LIC999A Facility Sketches for the Home and Yard, with the reported changes discussed during the annual inspection. The licensee has changed the days and hours of operation as indicated below.

Normal days and hours of operation are Monday- Friday, 5:30 AM to 6:00 PM, Weekends upon request.
OFF-LIMIT AREAS INCLUDE: Garage and the Entire 2nd Floor.

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 9 children in care.

· The Licensee is present in the home and has ensured that children in care are supervised. LPA observed the licensee with 2 assistants, however later determined they did not obtain a criminal background clearance.
· When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children. At this time the licensee is in the process of hiring a qualified assistant.
· 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 was tested and operating. No carbon monoxide detector device present in the home. The licensee stated they just replaced the smoke alarms in the home and the previous smoke alarm was a combination device. The new devices were inspected and do not detect Carbon monoxide gas.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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 16
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 334846206
VISIT DATE: 01/18/2024
NARRATIVE
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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 located in the garage. The Licensee set up the 2 car garage as an open area for parents and children to enter the facility, and which was designated as an Off-Limit area on 05/04/2022. Licensing Program Analyst observed the off-limit garage area open to children and families. LPA observed fishing poles, 2 cans of raid killer and off spray, large containers of liquid pesticides, miscellaneous cleaning supplies, yard equipment, landscaping supplies, and automotive liquid oils and supplies. An unlocked refrigerator located in the garage contained several bottles of drinking alcohol and prescription medications. No children were in the garage at the time of inspection and the licensee closed the garage in the presence of the licensee to make off-limits
· Storage of poisons are NOT inaccessible to children and are NOT locked. At 10:29 AM LPA observed kitchen knives, Clorox bleach clean-up spray and bleach wipes accessible to children in unlocked lower kitchen cabinets.
· A fireplace in the home was observed to have a screen.
· No guns or weapons present as stated by the Licensee. Licensee Susana Gonzalez, understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· Stairs are not observed to be barricaded on 01/18/2024 where children under 5 years of age are present and in care. The licensee stated they removed the barrier due to one of the latches braking.
· Home is clean and orderly, with heating and ventilation for safety and comfort.
· Clean, Safe and age-appropriate toys and equipment are NOT present for indoors. LPA observed a baby bouncer. The licensee stated a parent brought it for their child and removed the equipment to the garage. No children were observed in the bouncer at the time of the inspection. Clean, Safe and age-appropriate toys were observed for outdoor activities.
· Outdoor play areas are fenced and/or appropriate supervision is present.
· Verification of control of property on file by rental agreement on 03/01/2022.
· Property owner/landlord notification and consent on file 03/08/2022.
· Pediatric CPR and First Aid training on 12/02/2023; Card expires on 12/02/2025.
· Health, Safety and Nutrition Certificate - completed on 06/25/2017, NO LEAD CERTIFICATE ON FILE.
· Mandated reporter General: Not on file; AB 1207 Child Care Expired: 09/2023
· Fire clearance: 05/03/2022,
· Documentation of fire/earthquake drills to be conducted every six months, Last drill 01/04/2024 at 10:30 AM.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 16
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 334846206
VISIT DATE: 01/18/2024
NARRATIVE
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· There are no bodies of water, 01/18/2024. Licensee Susana Gonzalez, 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. 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 were not complete; 4 infants missing sleep logs, No children on LIC9040 Facility roster, 3 children missing LIC9150, 1 child missing immunization records, LIC9227 not updated.
· Staff’s files are NOT complete: 2 Staff present did not have files for review and did not receive a criminal record clearance prior to working at the facility. Staff files were reviewed for staff not present and were not complete. A total of 4 staff missing immunizations for Measles, pertussis and Influenza or letter to decline, record of TB screenings, proof of Mandated Reporter Training, 3 staff LIC9108, LIC9052.
· A review of staff records on 01/18/2024 indicates that 2 staff present and caring for daycare children who require caregiver background checks have not received criminal record and child abuse index clearances or exemptions. 1 staff present began employment in 06/2023 and a 2nd staff present began employment on 01/17/2024. At 8:34 AM the licensee Susana Gonzalez, stated that she has 3 hired staff who are all out for personal reasons and therefore the licensee stated they needed to find substitutes but by admission stated the assistants present and not present have not completed the fingerprint process.

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. 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

Licensee Susana 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.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
Page: 3 of 16
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 334846206
VISIT DATE: 01/18/2024
NARRATIVE
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LPA Susan Brewer, discussed the safe sleep regulations with licensee Susana Gonzalez 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. LPA also informed licensee S. Gonzalez, 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.

Deficiencies were issued on today’s date for 2 Type A violations and Type B violations. LPA Susan Brewer, informed licensee Susana Gonzalez that this report dated 01/18/2024 document(s) 2 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Susan Brewer, informed the licensee Susana Gonzalez, to provide a copy of this licensing report dated 01/18/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A Civil Penalty has been assessed during this inspection 01/18/2024. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee Susana Gonzalez.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
Page: 4 of 16
Document Has Been Signed on 01/18/2024 04:30 PM - It Cannot Be Edited


Created By: Susan Brewer On 01/18/2024 at 02:41 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 334846206

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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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2
3
4
Based on observation, the licensee did not comply with the section cited above in LPA observed poisons, toxins, drinking alcohol, medications in open areas of the garage open to daycare children; kitchen knives and clorox spray cleaners and wipes in lower kitchen cabinets, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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2
3
4
The licensee agrees to ensure 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 and submit proof of the correction on or before close of business day 01/19/2024, by fax or e-mail.
Type A
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in 2 staff present and working with children did not receive a criminal record clearance prior to working with children, 3 additional staff not present are subject to a criminal record review, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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2
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4
The licensee agrees to ensure all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility and submit proof of a livescan receipt for employees, and submit proof of documentation to the department by mail or e-mail before the close of business day on 01/19/2024.
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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024


LIC809 (FAS) - (06/04)
Page: 5 of 16
Document Has Been Signed on 01/18/2024 04:30 PM - It Cannot Be Edited


Created By: Susan Brewer On 01/18/2024 at 02:41 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 334846206

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on observation interview, the licensee did not comply with the section cited above in the licensee failed to ensure one or more carbon monoxide detectors in the facility that meet the standards were installed in the home which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/22/2024
Plan of Correction
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The licensee agrees to ensure one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12, and submit proof of the installed device on or before close of business day on 01/22/2024.
Type B
Section Cited
CCR
102417(g)(3)
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: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation and interview, the licensee did not comply with the section cited above in the licensee by admission stated they removed equipement to barricade stairs in the home, where 9 children under 5 years of were present at the facility which poses posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/22/2024
Plan of Correction
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The licensee agrees to ensure the home shall be free from defects or conditions which might endanger a child and where children are less than five years old are in care, stairs shall be fenced or barricaded. The licensee also agrees to submit proof of a barricade for stairs by fax or e-mail by 01/22/2024.
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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024


LIC809 (FAS) - (06/04)
Page: 6 of 16
Document Has Been Signed on 01/18/2024 04:30 PM - It Cannot Be Edited


Created By: Susan Brewer On 01/18/2024 at 02:41 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 334846206

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above, the licensee failed to ensure 4 play yards for 4 infants present and in care were free from blankets and toys, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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2
3
4
The licensee agrees to ensure cribs or play yards shall be free from all loose articles and objects and submit a written statement of understanding for the licensee and staff, regarding the Infant Safe Sleep standards. The licensee agrees to submit the written statement by fax or e-mail on or before close of business day 01/19/2024.
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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2
3
4
Based on record review, the licensee did not comply with the section cited above in the licensee failed to ensure facility employees complete the mandated reporter training withing 90 days of hire, and the licensee failed to complete a renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training, which expired in 09/2023 and which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/19/2024
Plan of Correction
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2
3
4
The licensee agrees to ensure employees 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 on or before 02/19/2024, then submitt proof of their training certificates to the department by fax or e-mail.
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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024


LIC809 (FAS) - (06/04)
Page: 7 of 16
Document Has Been Signed on 01/18/2024 04:30 PM - It Cannot Be Edited


Created By: Susan Brewer On 01/18/2024 at 02:41 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 334846206

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in the licensee failed to obtain the LIC627 Medical Consent from the authorized representative of a child in care which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/22/2024
Plan of Correction
1
2
3
4
The licensee agrees to ensure all required documentation to include medical consent is maintained for each child in care and provide proof of the LIC627 Medical consent for a subject child on or before 01/22/2024 or the next time the child is in care, by fax or e-mail.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in the licensee failed to maintain sleep logs for infants under 24 months of age, enrolled at the facility which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/22/2024
Plan of Correction
1
2
3
4
The licensee agrees to submit proof of infant sleep logs with 15 minute checks for infants in care and submit proof of documentation on or before close of business day on 01/22/2024.
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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024


LIC809 (FAS) - (06/04)
Page: 8 of 16
Document Has Been Signed on 01/18/2024 04:30 PM - It Cannot Be Edited


Created By: Susan Brewer On 01/18/2024 at 03:51 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 334846206

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418
102418 Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in the licensee failed to obtain immunization records for a child present and in care, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/22/2024
Plan of Correction
1
2
3
4
The licensee agrees to submit proof of immunization records for a subject child enrolled and receiving care at the facility and send proof of documentation to the department on or before 01/22/2024 by fax or e-mail.
Type B
Section Cited
HSC
1597.622(a)(1)
1597.622(a)(1) Employees or volunteers at family day care home; immunization requirements; records; exemptions
-(a) (1) Commencing September 1, 2016, 1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
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Based on record review, the licensee did not comply with the section cited above in the licensee failed to ensure 2 employees present and working with daycare children have been immunized for measles, pertussis and influenza or have submitted a letter to decline influenza, nor have the staff completed a screening for Tuberculosis, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/22/2024
Plan of Correction
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The licensee agrees to ensure all employees or volunteers at family day care home; immunization requirements; records; exemptions and a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year, and complete screenings for Turberculosis, and submit proof to the department on or before 01/22/2024.
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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024


LIC809 (FAS) - (06/04)
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