426217183-2-21-2025-17-CC-JMEZ-DE52T2-20250221164000

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426217183
Report Date: 12/19/2024
Date Signed: 02/21/2025 04:40:40 PM

Document Has Been Signed on 02/21/2025 04:40 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	GONZALEZ INIGUEZ FAMILY CHILD CARE		FACILITY NUMBER:	426217183
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	12/19/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Ana Gonzalez		TIME VISIT/ INSPECTION COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 12/19/2024, at 10:00 AM, Licensing Program Analysts (LPA) Joaquin Mendez and Fernando Hernandez conducted an announced Pre-licensing Inspection and met with Applicant, Ana Gonzalez. LPA’s informed Applicant of the nature and purpose of the inspection. The applicant informed the LPAs of the intention to maintain operating hours of a Family Childcare Home (FCCH) from 5:00 AM to 4:30 PM, Monday- Friday. The applicant also informed the LPAs of the intention to provide care for children newborn to 13 years of age. Applicant was informed changes in licensing hours and/or the ages of children supervised and cared for can be altered upon notifying CCLD in writing of the given modifications and/or changes. The applicant reports there three (3) adults that live in the home and three (3) adults have received criminal record clearance. LPA’s note that at the time of inspection there was the applicant alone in the home. LPAs toured the interior and exterior of the residence with the Applicant. This is a single-story home. The home consists of four (4) bedrooms, two (2) bathrooms, living room area, dining room, kitchen, garage (which has been converted into an ADU), washroom, and back outdoor patio and yard. The applicant stated daycare services will occur in the living room, kitchen, dining room, hallway bathroom, one (1) bedroom (furnished daycare room), and part of the backyard area. LPAs note, the three (3) other bedrooms and one (1) bathroom, and garage (ADU), will be inaccessible to children in care. LPAs observed, there is an ADU on the property. The ADU has its own address and will be noted, the address for ADU as 1817 Canopy Dr. #A Santa Maria Ca. 93458. The Santa Maria City Permit was given to LPA’s during inspection and will be added to file in the R.O. LPAs observed that the bedroom (furnished daycare room), living room, kitchen, dining room, one (1) bathroom, and back yard to have plenty of spacing and ventilation for the comfort of children in care. · The bathroom was clean and orderly. Continued on LIC809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GONZALEZ INIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 426217183
	VISIT DATE: 12/19/2024

NARRATIVE

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·LPAs note there are no toxins and dangerous items in the bathroom accessible to children in care.
· The home has smoke detector, on the ceiling in the living room and was tested at 10:13 AM and was operable.

· There is no carbon monoxide detector. The applicant has a combination smoke and carbon monoxide detector new and in the box. LPAs informed the applicant the combo unit must be mounted and functioning. The applicant stated once she has the combination unit mounted, she will send a video to LPA’s at the number provided for proof once complete.

· LPAs notes, the applicant does have multiple sleep mats, a crib, and a playpen to meet the children’s sleeping needs.

· LPAs observed items, equipment, toys, and furnishings for the children in care that are in good condition and age appropriate. LPAs advised the Applicant to check daily for anything which may pose a threat to children in care prior to children having access to play structures and toys.

· LPAs reminded the Applicant of the importance of monitoring infants and keeping up with the infant safe sleep plan and log.

· Knives are stored in locked cabinet in the kitchen.

· Dish soap and cleaning supplies are in the locked washroom making it inaccessible.
· Family medication is locked box in the applicant’s bedroom and inaccessible. LPAs reminded the applicant the importance of always securing the room prior to daycare hours.
· LPAs observed a required fire extinguisher (2A10BC) in the home mounted on the kitchen wall with a purchase date 10/15/2024. LPAs reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually.
· Applicant reported drinking water will be accessible by means of filtered water in the home, individual water cups will be supplied to the children in care.

LPAs observed the back yard patio area to be completely fenced with wood fencing. However, the backyard needs secure fencing preventing access to area with yard equipment and hazardous materials (yard tools, drills, saws, chemicals) which could pose harmful for children.
Continued on LIC809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GONZALEZ INIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 426217183
	VISIT DATE: 12/19/2024

NARRATIVE

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Applicant reported there are no guns and ammo in the home where the FCCH will operate.

LPAs record review revealed all documents as noted below.
· Applicant completed FCCH orientation on 6/06/2024.

· Preventative Health training was complete on 7/12/2024.

· Pediatric CPR/First Aid (EMSA approved) and expires 06/21/26.
· Applicant completed Mandated Reporter training which expires 6/10/2026.
· LPAs observed immunization records for all adults residing in the home. LPAs reminded Applicant of obligation to maintain current training and certifications.
· Applicant does not have liability insurance for the license yet. LPAs provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282).

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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

The applicant, Ana Gonzalez provided proof of control of property.

APPLICANT Ana Gonzalez stated she will decide later to provide Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/. http://www.ada.gov/childqanda.htm

Continued on LIC809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GONZALEZ INIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 426217183
	VISIT DATE: 12/19/2024

NARRATIVE

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LPAs reviewed with applicant Ana Gonzalez, the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

LPAs discussed the safe sleep regulations with applicant, 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 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.

On this date, 12/19/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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 platforms. 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

Continued on LIC809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GONZALEZ INIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 426217183
	VISIT DATE: 12/19/2024

NARRATIVE

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Applicant, informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.
The home does not meet Title 22 Division 12 requirements of a small FCCH license. The application is pending subject for completion of the following:
- Carbon monoxide detector must be mounted and functioning prior to licensing.
- Backyard area needs a secure fence preventing access to area where yard tools and other hazardous materials are which can pose harm to children in care.
Corrections will be sent by photo to LPAs by the end of business day 1/02/2024.

A notice of site visit was given to applicant Ana Gonzalez, and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the applicant, Ana Gonzalez

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

LIC809 (FAS) - (06/04)

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