426216603-5-5-2023-17-CC-MBRT-CRJPV8-20230505113843

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216603
Report Date: 05/05/2023
Date Signed: 05/05/2023 11:38:49 AM

Document Has Been Signed on 05/05/2023 11:38 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 FAMILY CHILD CARE		FACILITY NUMBER:	426216603
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	05/05/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Mary Gonzalez		TIME COMPLETED:	11:48 AM

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On May 5^th 2023 at 9:31 AM, Licensing Program Analyst (LPA) Rosie Breault conducted an announced inspection for the purpose of performing a pre-licensing inspection. LPA met with applicant Mary Gonzalez and discussed the purpose of the inspection. LPA and applicant together toured the interior and exterior of the home.

During this tour the following was noted:

At the time of the inspection, applicant, husband, and child (under 10 years of age) were present in the home. Residing in the home will be applicant, husband, two (2) children – one six years of age, one thirteen (13) years of age. Per applicant, the operating hours will be Monday through Friday from 7:40am – 5:30pm.

All areas identified on the facility sketch were inspected. This is a single home which consists of three (3) bedrooms, one and a half (1.5) restrooms, one (1) living room, kitchen, dining room, garage, and outdoor play area. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Off limit areas included: All three bedrooms secured by locks, master bathroom, garage secured by door lock, and kitchen secured by gate.

Applicant stated that children will have access to living room, dining room, one (1) bathroom, and outdoor play area.

CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 426216603
	VISIT DATE: 05/05/2023

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LPA observed age-appropriate toys, play equipment and material for children in care. Knives and medication for the family are stored out of children’s reach, inaccessible to children by kitchen gate and elevated cabinets. The outdoor play area has age-appropriate toys, soft surface, and shaded area. LPA observed home to have permitter fencing with lock and shed with lock. LPA observed one spa in the outdoor area. At the time of the inspection, the spa was covered with lock and cover was strong enough to completely support the weight of an adult. Husband of applicant tested the weight of the cover at approximately 9:50am by standing on the spa, and it supported him. LPA reminded all locks shall be placed on the spa while children are in care.

The required fire extinguisher 2A10BC was purchased on May 1, 2023. Combination smoke detector and carbon monoxide detector was tested at 10:01am and was functioning at the time of the inspection. Applicant was reminded to service or purchase new fire extinguisher yearly. Per applicant, there are firearms and ammunition present on property. At the time of the inspection, LPA observed storage for firearms were in a locked combination safe, and ammunition stored separately in a secondary locked combination safe.

LPA observed two (2) wall heaters in the home. LPA advised heaters must be rendered inaccessible to children prior to licensure.

The applicant completed the FCCH Orientation on 1/25/2023. The applicant has current Pediatric First Aid and CPR which expires 3/11/2025. Applicant took the completed Preventative Health on 2/23/2023. Applicant completed the Mandated Reporter training on 3/14/2023.

LPA reviewed with applicant the LIC311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GONZALEZ FAMILY CHILD CARE	FACILITY NUMBER: 426216603
	VISIT DATE: 05/05/2023

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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant, provided applicant with Safe Sleep Information handout, 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. LPA also informed Applicant 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

At this time, the home does not meet Title 22 Division 12 requirements of a small FCCH license, pending confirmation of 2 (two) wall heater covers.

An exit interview was conducted, report reviewed, and copy provided to applicant.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

LIC809 (FAS) - (06/04)

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