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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700220
Report Date: 07/28/2022
Date Signed: 07/28/2022 03:11:19 PM

Document Has Been Signed on 07/28/2022 03:11 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:GONCALVEZ DE BROWN FAMILY CHILD CAREFACILITY NUMBER:
367700220
ADMINISTRATOR:ANA GONCALVEZ DE BROWNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 475-7680
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:44 PM
MET WITH:Ana Goncalvez de Brown TIME COMPLETED:
03:09 PM
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Licensing Program Analyst (LPA) Steven Montoya conducted an unannounced Required 1 Year inspection at the above large child care home. Upon arrival, the LPA met with licensee Ana Goncalvez de Brown, who guided the LPA to tour of the facility. Individuals that reside in the home include 2 adults (licensee, her adult daughter). Per LIS, facility annual fees are current. All adults living in the home have been background cleared. Per licensee, the hours of operation are Monday through Friday 6:30 a.m. to 5:00 p.m. Email: anabrown28@gmail.com li

The Home is set up as follows:
This is a single story house with 4 bedrooms, 3 bathrooms, kitchen/dining room, family/daycare room, living room, and attached garage. Per Licensee the living room, and family room/kitchen, 1 bathroom and bathroom are utilized for the family child care activity area. Per licensee off-limit areas of the home is the 3 bedrooms, master bathroom, laundry room, and garage. The home was inspected for safety, comfort, cleanliness, telephone service, central air and heat and ventilation.

Main Area: Main care will be conducted in the living and bedroom. There is a security gate located prevents children from accessing off limit areas.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GONCALVEZ DE BROWN FAMILY CHILD CARE
FACILITY NUMBER: 367700220
VISIT DATE: 07/28/2022
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Family room/ Daycare area: In the Family room which is the designated playroom, LPA observed age-appropriate toys and furniture for the children. A small table was observed with a total of eight chairs. Several plastic storage bins were observed in which games and toys are stored for the children. There are games and books on the premises of this facility. There are mats on the floor that have educational/learning activities on them. The mats were observed to be in good condition. The home has central heating and air conditioning. All windows have screens and are free of cracks, bugs, and debris. Hanging window blinds cords are inaccessible to children.

Family Room: In the family room a fireplace was observed that was properly. In the family room, there were additional toys observed to be in the room stored on cubbies.

Kitchen The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children (Safety latches). LPAs inspected the kitchen and observed that all lower cabinets and drawer have child proof latches that are in good condition.

Bathroom #1: Children utilize a bathroom that is in the Guest room. Bathrooms were toured, and inspected sink/toilet are in operable condition. Toilet and faucets are clean, safe, and operable. All poison and medications are made inaccessible to children with child safety latches on the sink cabinet.

Backyard: The backyard was inspected; the backyard is dirt landscaping surrounded by Brick fencing. Children have access to the backyard. LPA observed, a plastic kid's slide and toys, other age appropriate toys. LPA did not observe a swimming pool or bodies of water on the premises. LPA observed 3 dogs, 2 cats and 3 rabbits and reviewed pet vaccinations According to Licensee, ensure that children are always supervised while outside in the backyard.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GONCALVEZ DE BROWN FAMILY CHILD CARE
FACILITY NUMBER: 367700220
VISIT DATE: 07/28/2022
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Documentation:
· CPR/First Aid: LPA observed licensee has expired Pediatric CPR and First Aid Training with expiration date (08/2020) and has an appointment: 8-06-2022. 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.
· Immunization: The licensee has the required immunization. The licensee provided a written statement declining the influenza vaccination.
· Mandated Reporter Training: The licensee has completed the online mandated reporter training at www.mandatedreporterca.com, and need to renew by 04/12/2022.
· Transportation: The licensee does not provide transportation for children.
· Staff File: Her 19 years old daughter is her assistant
· Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 09/03/2021 .

Safe Sleep: LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GONCALVEZ DE BROWN FAMILY CHILD CARE
FACILITY NUMBER: 367700220
VISIT DATE: 07/28/2022
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Safe Sleep: LPA discussed the safe sleep regulations with licensee 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 [facility representative] 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.

The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.

Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.


n Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

The Regional Office in Palmdale has a Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.

LPA provided consultation during the inspection.

No Deficiencies cited.


Exit interview conducted and inspection report, appeal rights and notice of site visit was reviewed with the licensee Ana Goncalvez de Brown.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC809 (FAS) - (06/04)
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