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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500171
Report Date: 04/15/2022
Date Signed: 04/15/2022 05:00:28 PM

Document Has Been Signed on 04/15/2022 05:00 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, MA NATIVIDADFACILITY NUMBER:
394500171
ADMINISTRATOR:GARCIA, NATIVIDADFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 642-3525
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
04/15/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Ma Natividad GonzalezTIME COMPLETED:
05:30 PM
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On Friday, April 15, 2022, Licensing Program Analyst (LPA), Elvira Sierra and Licensing Program Manager (LPM) Bettina Engelman met today with Licensee, Ma Natividad Gonzalez for a Plan of Correction (POC) inspection. A follow up evaluation was conducted on today inspections to verify that the corrections have been accomplished within the agreed time frame. Upon arrival present in the facility was Licensee's Assistant, Briana Roman caring for six children (2 infants and 4 preschool children). Licensee arrived later during the inspection with 3 children (one infant, and 2 school age).

LPA checked all the areas in the home including off limit areas. Licensee is within capacity limits during visit. Also LPA observed that the gate leading to the second floor has been installed. LPA observed cribs for the infants. There were no blankets on top of the infants and there were no blankets inside the cribs. LPA and LPM reviewed children's files and the files had complete records, including signed "Acknowledgment of Receipt of Licensing Reports" (LIC 9224) from past deficiencies issued. The facility is in compliance today.

Deficiencies issued on April, 06, 2022, are cleared as a today.

Notice of Site Visit and Appeal of Rights were provided. Notice of Site Visit should remain posted for 30 says. Exit interview conducted and report was reviewed with the Licensee, Ma Natividad Gonzalez.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2022
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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