343617731-2-27-2023-53-CC-SMAY-CPG2RP-20230227163752

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343617731
Report Date: 02/27/2023
Date Signed: 02/27/2023 04:38:00 PM

Document Has Been Signed on 02/27/2023 04:38 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, R. KARMYNA		FACILITY NUMBER:	343617731
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 5	DATE:	02/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Karmyna Gonzalez		TIME COMPLETED:	04:55 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

On February 27, 2023, Licensing Program Analyst (LPA) Salene Mayberry met with Licensee Karmyna Gonzalez for the purpose of an unannounced annual random inspection. Also present during the inspection was Licensee’s husband/assistant Gerardo Gonzalez and her adult son Saul Gonzalez. Facility hours of operation are Monday through Friday 6:00 am to 6:00 pm and other hours as arranged. Licensee states she does transport children. A review of the Facility Personnel Summary shows that all adults living and working in the home have criminal record clearances on file with Licensing office. Licensee stated that no new residents have moved into the home since licensure. Capacity specified on the license was met during today’s inspection. Present in the facility were 5 children. LPA verified the annual fees are current.

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.

A health and safety inspection was conducted inside and out. The two-story home has 4 bedrooms, 2.5 bathrooms and a garage. LPA observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Rights. LPA also observed a current roster and confirmed that fire drills are conducted at least once every six months. LPA verified the facility maintains a working phone, has a 3A40BC fire extinguisher, and functioning smoke and carbon monoxide detectors. LPA observed that all hazardous and personal hygiene items are inaccessible to children in care. Licensee stated there are no weapons in the home. LPA observed a fireplace in the home that was appropriately barricaded to prevent access by children.

Report continued on LIC809-C.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023

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 4

Document Has Been Signed on 02/27/2023 04:38 PM - It Cannot Be Edited

Created By: Salene Mayberry On 02/27/2023 at 03:27 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: GONZALEZ, R. KARMYNA	FACILITY NUMBER: 343617731
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	LPA observed that Licensee and her assistant did not have current Pediatric CPR and First Aid certifications. Licensee and her assistant’s certifications both expired in December 2020, which poses a potential risk to the health and safety of children in care.
	POC Due Date: 03/07/2023
	Plan of Correction
1 2 3 4	During today's visit Licensee and her assistant provided LPA with confirmation of enrollment in an approved EMSA course on March 3rd and 4th. Upon completion of the course they will provide current copies of their certification to LPA.

Type B

Section Cited

CCR

102418(g)(1)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	LPA observed 6 of 8 children’s files that had incomplete immunization records or no immunization records on file. This poses a potential risk to the health and safety of children in care.
	POC Due Date: 03/14/2023
	Plan of Correction
1 2 3 4	Licensee will request updated immunization records from all families in care and provide LPA with the completed documents.

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:

Bettina Engelman

LICENSING EVALUATOR NAME:

Salene Mayberry

LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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, R. KARMYNA	FACILITY NUMBER: 343617731
	VISIT DATE: 02/27/2023

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
26
27
28
29
30
31
32

The stairs in the home are appropriately barricaded with a child gate to prevent access. The outdoor play space is completely enclosed. LPA observed a tool shed in the back yard and confirmed it is inaccessible to children in care. There are no bodies of water on the premises.

Off-Limit areas are: the entire upstairs and garage. Licensee acknowledged that children are never allowed in any off-limit areas. Off limit areas will remain inaccessible by closed doors, gates, locks, and supervision.

LPA reviewed 8 children’s files during todays inspection. LPA observed 6 of 8 children’s files that had incomplete immunization records or no immunization records on file. Licensee will request updated immunization records from all families in care and provide LPA with proof. In addition, LPA observed that 7 out of the 8 files reviewed had incomplete Identification and Emergency Information (LIC700) forms. 2 files had incomplete forms, 3 files were completed on outdated Sacramento County Licensing forms from 1999 and 2 files were completed on Residential Facilities form LIC601. Finally, LPA observed that 6 of the 8 files reviewed had either missing or incomplete Consent for Medical Treatment (LIC627) forms. 3 of the children’s files were missing the form and 3 were completed on outdated Sacramento County Licensing forms from 1999. Licensee will provide LPA with all missing documents by Tuesday, March 14th.

LPA did not observe current Pediatric CPR and First Aid certifications for Licensee and her assistant. Licensee and her assistant’s certifications both expired in December 2020. During today's visit Licensee and her assistant provided LPA with confirmation of enrollment in an approved EMSA course on March 3rd and 4th and will provide LPA with certification copies upon completion.

LPA did not observe current AB1207 Mandated Reporter certificates for Licensee or her assistant. Licensee had not received a visit from Licensing since January 2018. LPA verified Licensee and her assistant enrolled in a course during today's visit and they will complete the training and provide LPA with their individual certificate of completion by Tuesday, March 2, 2023. LPA discussed the requirement to renew the mandated reporter training every two years and provided the Mandated Reporter training website: www.mandatedreporterca.gov.

Report continued on LIC809-C.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

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, R. KARMYNA	FACILITY NUMBER: 343617731
	VISIT DATE: 02/27/2023

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
26
27
28
29
30
31
32

Incidental Medical Services (IMS) was discussed. Licensee understands that when any IMS is provided, a Plan for Providing IMS must be submitted to Licensing.

LPA discussed the safe sleep regulations with Licensee and provided a brochure, Frequently Asked Questions printout and 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 provided a copy of the Individual Sleeping Plan (LIC9227), for infants under 12 months to Licensee.

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 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.

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.

Finally, Licensee was encouraged to the visit the Department's website at www.cdss.ca.gov for information regarding child care updates, forms, regulations and legislation pertaining family child care homes.

Two Type B deficiencies were cited on the subsequent page (LIC809-D) of this report.

An Exit interview conducted, and the report was reviewed with Licensee. LPA provided Licensee with a copy of the report, Appeal Rights and posted a Notice of Site visit. Licensee understands the Notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4