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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617893
Report Date: 08/02/2024
Date Signed: 08/02/2024 03:25:47 PM

Document Has Been Signed on 08/02/2024 03:25 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:OCMIN,DAYSI/GONZALEZ,JORGEFACILITY NUMBER:
343617893
ADMINISTRATOR/
DIRECTOR:		OCMIN,DAYSI/GONZALEZ,JORGEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 678-2499
CITY:SACRAMENTOSTATE: CAZIP CODE:
95833
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 4DATE:
08/02/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Jorge GonzalezTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analysts Loraine Perez and Jennifer Velasco (LPA) met with Licensee Jorge Gonzalez for the purpose of a case management inspection. The purpose of today's inspection was explained. LPAs observed 4 children in care with the Licensee and 1 staff.

Upon arrival LPAs observed the stairway with a gate that was left open. LPAs closed the gate and later it was observed open, so LPAs closed it again. This poses a potential health and safety risk to the children in care. At arrival the children were resting on mats and one infant was in a portable play yard with a blanket. The infant was awake for the duration of the visit. LPAs advised the Licensee to remove the blanket from the portable play yard. The licensee immediately removed the blanket from the portable play yard. The blanket poses an immediate risk to the health and safety of the infant in care.

Based on today's inspection and record review, one Type A deficiencies have been issued on the attached LIC809-D page. Licensee shall provide a copy of this licensing report 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. Exit interview was conducted with Licensee, appeal rights were provided, and A notice of site visit was given to the Licensee who will post it where visible to parents/guardians for 30 days, along with the LIC 809 and LIC 809-D. A signed Acknowledgement of Receipt of the Licensing Report (LIC 9224) must be placed in the child's file for verification.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2024
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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Document Has Been Signed on 08/02/2024 03:25 PM - It Cannot Be Edited


Created By: Loraine Perez On 08/02/2024 at 02:49 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OCMIN,DAYSI/GONZALEZ,JORGE
FACILITY NUMBER: 343617893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/05/2024
Section Cited
CCR
102425(b)

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102425 (b) Cribs or play yards shall be free from all loose articles and objects.
This requirement was not met as evidenced by LPAs’ observations that a napping infant was in a portable crib with a blanket over them.
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Licensee stated he will no longer place anything in the crib.
LPA will return for POC

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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:Amanda Blesi
LICENSING EVALUATOR NAME:Loraine Perez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/02/2024 03:25 PM - It Cannot Be Edited


Created By: Loraine Perez On 08/02/2024 at 02:52 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OCMIN,DAYSI/GONZALEZ,JORGE
FACILITY NUMBER: 343617893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/05/2024
Section Cited
CCR
102417(g)(3)

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102417 (g)(3) The home shall be free from defects or conditions which might endanger a child … stairs shall be fenced or barricaded

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Licensee stated he will check the gate throughout the day.
LPA will return for POC
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This requirement was not met as evidenced by LPAs’ observations that the gate for the stairs to the second floor was open.
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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:Amanda Blesi
LICENSING EVALUATOR NAME:Loraine Perez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2024


LIC809 (FAS) - (06/04)
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