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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627650
Report Date: 09/06/2024
Date Signed: 09/06/2024 01:08:39 PM

Document Has Been Signed on 09/06/2024 01:08 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GONZALEZ, ARACELI FAMILY CHILD CAREFACILITY NUMBER:
376627650
ADMINISTRATOR/
DIRECTOR:		ARACELI GONZALEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 760-4984
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
09/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Cynthia RodriguezTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 9/6/24 at 12:15pm, Licensing Program analyst (LPA) Adrian Castellon conducted an unannounced case management inspection to follow up on a self reported unusual incident reported to the Department via telephone call. Licensee Araceli Gonzalaez telephoned LPA Castellon on 9/3/24.

Upon arrival, LPA met with assistant Cynthia Gonzalez and disclosed the purpose of the inspection. Licensee Araceli Gonzalez arrived within 20 minutes of LPA arrival. There were two children present.

On 9/3/24, licensee Gonzalez advised LPA Castellon that child in care (C1) fell while being hugged while dancing with another child in care. Assistant Cynthia Gonzalez was present during the incident. Assistant states that she turned to get the remote to change the song playing when she heard the children fall. Assistant checked children and observed that C1 had hit her head on the base of a shelf and was bleeding. First aid was applied and parents were called immediately. Father arrived within 20 minutes and took child to ER. LPA spoke with C1's mother and verified licensee's account of injury.

LPA reminded licensee to submit LIC624 within seven calendar days. Licensee states that she is waiting for ER report from parents.

LPA interviewed staff. LPA attempted to interview C1. Based on information obtained, the incidents appear to be an accident.

No deficiencies cited.

Exit interview conducted with licensee Gonzalez. Notice of Site Visit was provided and shall be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2024
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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