<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444406219
Report Date: 02/02/2023
Date Signed: 02/02/2023 03:42:10 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/26/2023 and conducted by Evaluator Cortney Nelson
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230126164041
FACILITY NAME:GONZALEZ, ELIZABETHFACILITY NUMBER:
444406219
ADMINISTRATOR:GONZALEZ, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 761-2190
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 17DATE:
02/02/2023
UNANNOUNCEDTIME BEGAN:
02:54 PM
MET WITH:Elizabeth GonzalezTIME COMPLETED:
03:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is operating out of ratio.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs), Cortney Nelson and Ashley Lopez, met with Licensee, Elizabeth Gonzalez, for unannounced 10-day complaint investigation. LPA's were admitted into the facility by the Licensee upon arrival.

LPA's toured inside and outside of the family day care home and observed seventeen (17) children in care (2 infants/ 15 preschool-age). Based on staff interview and observation, the preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED.

California Code of Regulations (Title 22, Division 12) are being cited on attached LIC9099-D.

***Report continues on LIC9099-C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 07-CC-20230126164041
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GONZALEZ, ELIZABETH
FACILITY NUMBER: 444406219
VISIT DATE: 02/02/2023
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
26
27
28
29
30
31
32
LPA's informed Licensee, Elizabeth Gonzalez, that this report dated 2/2/2023 documents one Type A citation, which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA's informed the Licensee to provide a copy of this licensing report dated (2/2/2023) that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Licensee, Elizabeth Gonzalez.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 07-CC-20230126164041
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GONZALEZ, ELIZABETH
FACILITY NUMBER: 444406219
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/03/2023
Section Cited
CCR
102416.5(a)
1
2
3
4
5
6
7
102416.5 Staffing Ratio and Capacity (a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Licensee will be subject to additional visits to ensure that she is within capacity requirements for a large FCCH. She will submit schedule of children enrolled that demonstrates how ratio will be maintained each day by 2/6/2023.
8
9
10
11
12
13
14
Upon arrival to the family child care home (FCCH), LPA's observed 17 children in care (2 infants and 15 preschool-age), which poses an immediate threat to the health, safety, and personal rights of children in care.
8
9
10
11
12
13
14
LIC9224 must be signed by all parents currently enrolled and submitted to Licensing by end of day 2/3/2024. LIC9224 and LIC9099 must be provided to all future enrollments for the next 12 months and maintained in file.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3