434417718-10-24-2023-07-CC-TTRO-CWWRHJ-20231024130227

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417718
Report Date: 10/24/2023
Date Signed: 10/24/2023 01:02:40 PM

Document Has Been Signed on 10/24/2023 01:02 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	GONZALEZ, ERICA		FACILITY NUMBER:	434417718
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	10/24/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Erica Gonzalez		TIME COMPLETED:	01:15 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	Licensing Program Analyst (LPA) Teodoro Trujillo met with Applicant, Erica Gonzalez, to conduct an announced pre-licensing change of location from a facility located in Merced County - 243911751. LPA was granted access to the home by the Applicant. No children were present in the home during today's inspection. The Applicant and her spouse, Raul and adult daughter are the adults residing in the home. There are three minor children residing in the home. Days and hours of operation will be Monday - Saturday from 6:00 AM to 6:00 PM. Applicant completed her Preventative Health and Safety Child Care Training on 01/20/2022 and a copy of the certification is on file. Applicants CPR and First Aid certifications are current and expire on 04/15/25. Copies of both certifications are on file. Applicant completed the Mandated Reporter Training for Child Care Workers on 12/09/2021, and a copy of the certification is on file. A copy of current TB test, flu, Mmr, and Tdap vaccinations for the Applicant are on file. Applicant rents the home and a copy of the lease agreement verifying control of property and Owner/Landlord Notification (LIC 9151) and Landlord Consent (LIC 9149) form are on file. Applicant understands that she cannot care of more than 8 children at any time. Applicant does not have liability insurance and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). LPA toured the indoor and outdoor areas of the home with the Applicant during today's inspection. The Applicant's home is single story home and LPA observed no stairs during today's inspection. There are no wall heater units in the home. Applicant states that she will operate the day care in the following areas: Living room, kitchen, dining room and one bathroom. Off limit areas inside the home: 3 bedrooms and bathroom next to kitchen. Off limit areas outside the home: detached garage, locked storage room, and fenced off dog yard area, and locked basement. The home is clean, orderly, (including heating/air conditioning), and ventilation for safety & comfort. There is sufficient toys, supplies, and equipment for the day care children both indoors/outdoors. LPA observed a fully charged fire extinguisher (3A40BC) and working smoke and carbon monoxide detectors, fenced backyard, and no bodies of water. Applicant states that she does not have any weapons/ammunition in the home. Applicant states her dog is vaccinated. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. Applicant states that poisons are stored in locked basement. LPA reminded Applicants that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes. Applicant states that she will not administer any medication to the children at this time. Applicant states that a child will be isolated in the dining room area if necessary due to illness or communicable disease. Applicant has a First Aid kit in the home. Continues report dated 10/24/2023 pg. 1/3

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GONZALEZ, ERICA	FACILITY NUMBER: 434417718
	VISIT DATE: 10/24/2023

NARRATIVE

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Continuation of report dated 10/24/2023 pg. 2/3
Applicant understands that children's personal rights should not be violated, including no corporal punishment. isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 10/24/2023 was reviewed and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions, applicant Erica Gonzalez was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the requirements of AB 633 with the Applicant. The Applicant understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations with the Applicant and advised her of the assessment of an immediate $500 civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

LPA provided and reviewed 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. LPA also discussed the importance of maintaining records for any person/assistant providing care to the children and children in the home under 10 years of age.

LPA discussed the safe sleep regulations with applicant Erica Gonzalez and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed applicant Erica 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.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GONZALEZ, ERICA	FACILITY NUMBER: 434417718
	VISIT DATE: 10/24/2023

NARRATIVE

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Continuation of report dated 10/24/2023 pg. 3/3
APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:
Incidental Medical Services (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: http://www.ada.gov/childqanda.htm

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 improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Applicant Erica Gonzalez was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with the Applicant, Erica Gonzalez, and LPA advised her that a small Family Child Care Home License is approved pending Licensing Program Manager approval.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC809 (FAS) - (06/04)

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