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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500464
Report Date: 09/14/2021
Date Signed: 09/14/2021 12:00:36 PM

Document Has Been Signed on 09/14/2021 12:00 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, PAULAFACILITY NUMBER:
394500464
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/14/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Paula GonzalezTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Christopher Jackson met with the applicant Paula Gonzalez for the purpose of a change of location inspection. LPA toured the single story home inside and out for a health and safety inspection. The single story home has an open front yard. Inside the home consists of a family upon entry, one bathroom, kitchen, bedroom #1, bedroom #2, and side den area. The backyard consists of a detached garage and fenced in dog run. The applicant stated they are in the process of adding artificial turf to the backyard area. Present during today's inspection was applicants adult son and husband. All adult residents have obtained a criminal record clearance from the department.

Off-limit areas include: Bedroom #1, bedroom #2, fenced in dog run and detached garage. Applicant understands that children may never enter these off-limit areas. LPA observed a fire extinguisher, carbon monoxide detector and smoke detector that meet regulation. Hazardous cleaning compounds and medications are stored inaccessible or out of reach for children in care. LPA observed the backyard is fenced and there are no bodies of water on the property. LPA discussed that 100% supervision is required in any unfenced areas.

Applicant owns the home and provided a copy of the mortgage statement for the home. LPA discussed the option of obtaining $300,000 liability insurance. LPA provided a copy of the LIC282 - Liability Insurance to the applicant during today's inspection. LPA provided the applicant with the community care licensing website (www.ccld.ca.gov) to access updated forms, and stay current on any changes to laws and regulations. LPA discussed with applicant of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov. LPA discussed the requirement for applicant to notify licensing for any modifications done to the home, inside and outside. LPA observed posted Emergency Disaster Plan and Parents' Rights Poster.

Report Continues on 809-C

SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2021
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, PAULA
FACILITY NUMBER: 394500464
VISIT DATE: 09/14/2021
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LPA discussed fire drills to be conducted at least once every six months. LPA observed the weapon in the home to be stored according to title 22 regulations. LPA discussed the infant sleep regulations with applicant. LPA explained infants 12 months and under must have the LIC 9227, infant sleep plan on file. In addition LPA explained that 15 minute checks must be done on all infants 24 months and under during their nap time. LPA provided applicant with a copy of LIC 9227. During the inspection LPA reviewed COVID19 practices and conducted a technical assistance tour of the facility to incorporate Department of Public Health safety protocols for operating during the pandemic. LPA discussed posting requirements and facility operations including sanitation and pick up/drop off procedures.

Effective 09/14/2021, LPA will approve the license for small family child care home. Facility is approved for a small family child care home license to serve a capacity of 6 children with no more than 3 infants or 4 infants only. Or with a capacity of 8 children: no more than 2 infants, 1 child in Transitional kindergarten or elementary school and 1 child at least age 6.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
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