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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406219
Report Date: 04/13/2023
Date Signed: 04/13/2023 04:45:27 PM

Document Has Been Signed on 04/13/2023 04:45 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GONZALEZ, ELIZABETHFACILITY NUMBER:
444406219
ADMINISTRATOR:GONZALEZ, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 761-2190
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 16DATE:
04/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Elizabeth GonzalezTIME COMPLETED:
04:57 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Cortney Nelson and Ashley Lopez, met with Licensee, Elizabeth Gonzalez, and explained purpose of today's visit. Upon arrival, LPAs were admitted into the home by the Licensee and additionally present was the Licensee's assistant, Rosie.

LPAs observed that the Licensee was caring for sixteen children (2 infants, 4 school-age, and 10 preschool-age) children, which is more than the maximum 14 children allowed for a large family child care home. The Licensee has previously been cited in the past 12 months for being over capacity on 2/2/2023 & 2/14/2023, this is a repeat violation, civil penalties have been issued.

LPAs conducted interviews with children and came to know that a child at the home had their personal rights violated by an assistant at the home grabbing her arms.

As a result of today's inspection, deficiencies have been cited, see LIC809-D.

LPA's informed Licensee, Elizabeth Gonzalez, that this report dated 4/13/2023 documents two Type A citations, 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 (4/13/2023) that documents two Type A citations 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: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
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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Document is an Amendment of Original Document on 09/26/2023 03:05 PM


Created By: Cortney Nelson On 04/13/2023 at 03:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 04/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/14/2023
Section Cited
CCR
102423(a)

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102423 Personal Rights (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee...These rights include, but are not limited to..: (4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature...
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POC has been cleared, the Licensee's assistant is no longer employed by the family child care home.
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This requirement was not met as evidenced by:

The Licensee did not ensure that children's rights as her assistant grabbed the children's arms which is an immediate risk to the health, safety, and personal rights of children in care.
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Type A
04/14/2023
Section Cited
CCR102416.5(a)

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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:
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This is the third citation for over capacity, the Licensee will be recommended an office visit at the San Jose Regional Office. Legal action may be taken for continued over capacity violations.
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The Licensee was caring for sixteen children (2 infants, 4 school age, 10 preschool-age), more than her licensed capacity, which poses an immediate risk to the health, safety, and personal rights of children in care.
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The Licensee will discuss drop in adjustments for the remainder of the school year to ensure she is within her capacity of no more than 14 children per day. The document will be signed by both the Licensee and the parents of drop-in children and submitted to the Department by 4/14/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2023


LIC809 (FAS) - (06/04)
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