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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216582
Report Date: 05/09/2024
Date Signed: 05/09/2024 11:24:38 AM

Document Has Been Signed on 05/09/2024 11:24 AM - 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GONZALEZ GARCIA FCCFACILITY NUMBER:
426216582
ADMINISTRATOR/
DIRECTOR:		ADRIANA GONZALEZ GARCIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 245-9058
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 5DATE:
05/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Adriana Gonzalez Garcia TIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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On May 9, 2024, at 10:30 AM Licensing Program Analyst (LPA) Martina Jimenez made an unannounced Case Management inspection to follow up on an Unusual Incident Report (UIR) received by the Department on 04/30/2024, concerning a child falling off the deck, cut their mouth and scraped their chin.

LPA met with Adriana Gonzalez Garcia, Licensee and Carlos Medina Gutierrez, assistant, and discussed the purpose of the inspection. The inspection is a follow up to a self reported incident involving a child was playing on the backyard patio deck with toy cars, child then ran off the two steps of the deck, causing the child to trip on child's own feet and cut above the mouth and scape the chin.

LPA discussed the incident with the Licensee. Licensee indicated the following 1st aid was provided to child. Licensee obtained a paper toilet, applied pressure to the cut, cleaned the cut, applied an ice pack, and notified the child's parents of the incident. Licensee discussed the incident in detail with mother at time of pick up and the following day the licensee discussed the incident in detail with child's father. The child did not require medical treatment. The child returned to care on 4/30/2024, with no restrictions.

Based on the information obtained from licensee as well as the LPA's observations, LPA determined there were no deficiencies and the licensee functioned in accordance with Title 22 regulations.

No deficiencies were cited during todays inspection. LPA observed licensee post the Notice of Site visit (LIC 9213).
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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