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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500171
Report Date: 02/01/2023
Date Signed: 02/01/2023 01:08:35 PM

Document Has Been Signed on 02/01/2023 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, 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: 33CENSUS: 5DATE:
02/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:MA Natividad GonzalezTIME COMPLETED:
01:30 PM
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On 02/01/23, Licensing Program Analysts(LPAs) Elvira Sierra and Stacey Williams met with the licensee, Ma Natividad Gonzalez for the purpose of an annual random inspection. Facility hours of operation are 24 hours a day 7 days a week year round with periodic breaks throughout the year. Licensee was advised never to exceed 24 hours of consecutive care. A review of the Facility Personnel Summary shows that all adults living and working in the home have criminal record clearances on file with Licensing Office. Licensee stated that no new residents moved into the home since licensure. Upon arrival present in the facility was Licensee caring for 4 children. One child was Licensee own child. Licensee's assistant arrived later during the inspection with her own child.

A health and safety inspection was conducted in all areas accessible to children. Off limit areas are: Entire second floor, Bedroom # 1, Pantry, storage shed in the backyard and Garage on ground floor. Licensee was reminded that day care children may never enter these off-limit areas. LPAs observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Rights by the main entrance. LPAs observed the home was clean and appropriately ventilated. Facility maintains a working phone, 2A10BC fire extinguisher, and functioning smoke/carbon monoxide detector. Licensee stated there are no weapons in the home. No bodies of water were observed on the premises. Toxic and hazardous items are inaccessible to children. Medications are kept in the pantry in the kitchen which is off limit. Stairs leading to the second floor are barricaded. Facility is fenced for supervision. Licensee stated she provides meals and provides transportation if needed.

LPAs reviewed 3 children's files. Licensee CPR expires on 03/24. Mandated Reporter training certificate was observed and expires on 03/02/24. LPAs observed a current roster and fire drills are conducted at least once every six months and are properly log. Last fire drill was conducted on 12/22.



Report continues on subsequent page 809C---
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: GONZALEZ, MA NATIVIDAD
FACILITY NUMBER: 394500171
VISIT DATE: 02/01/2023
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPAs 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. LPAs also informed licensee 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

A notice of site visit was posted and must remain posted for 30 days. 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: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC809 (FAS) - (06/04)
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