<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617731
Report Date: 12/19/2023
Date Signed: 12/19/2023 11:00:10 AM

Document Has Been Signed on 12/19/2023 11:00 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GONZALEZ, R. KARMYNAFACILITY NUMBER:
343617731
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
12/19/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Karmyna GonzalezTIME COMPLETED:
11:20 AM
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 12/19/23, Licensing Program Analyst (LPA) Jennie Tedlos conducted a Case Management visit for the purpose of increasing the licensed capacity from 8 to 14 children. LPA met with Licensee, Karmyna Gonzalez. Fire Safety Inspection Clearance was granted on 12/18/23 for a total capacity of 14 children. Facility hours of operation are Monday - Friday from 7:00 am to 6:00 pm. All individuals subject to criminal background review have obtained a criminal record clearance. LPA observed Licensee caring for 5 children.

A health and safety inspection was conducted in all areas accessible to children. Home appears orderly and suitable for children. Off-limits areas include: entire upstairs, and backyard shed. The 2 car garage was made on-limits via fire safety inspection and is converted into a playroom. The 1 car garage is also on-limits. Hazardous items were stored inaccessible to children. The stairs were properly barricaded with a child's gate. Napping equipment and age-appropriate toys were observed. Licensee stated there are no weapons in the home. Home has a working telephone, a 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. The backyard is fenced for supervision. Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes.



Current CPR & First Aid was verified and expires in 2025. LPA reviewed large family childcare home capacity limitations with licensee.

Capacity increase is approved as of today, 12/19/23. The facility is licensed to serve a MAX. CAP (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6. LICENSEE UNDERSTANDS THAT WHEN ASSISTANT IS NOT PRESENT, THE CAPACITY REVERTS TO A SMALL FAMILY CHILD CARE HOME.



Continued on LIC809-C...
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GONZALEZ, R. KARMYNA
FACILITY NUMBER: 343617731
VISIT DATE: 12/19/2023
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
An exit interview was conducted, and the report was reviewed with Karmyna Gonzalez, to keep on file at the facility. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

No deficiencies were cited during today’s visit.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2