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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406219
Report Date: 09/27/2023
Date Signed: 09/27/2023 02:06:03 PM

Document Has Been Signed on 09/27/2023 02:06 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: 23CENSUS: 11DATE:
09/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:53 AM
MET WITH:Elizabeth GonzalezTIME COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Cortney Nelson and Deanna Villagrana, met with Licensee, Elizabeth Gonzalez, and explained purpose of visit, to conduct case management visit and amend civil penalties issued on 2/14/2023 & 4/13/2023. Upon arrival, LPAs were admitted into the home by the Licensee and observed there were eleven children (1 infant, 10 preschool-age, 1 school-age) in care with the Licensee and Assistant, Claudia, present.

Civil penalties were assessed on 2/14/2023 & 4/13/2023 for repeat violations totalling $1,000 for each, however the civil penalties assessed should have been $250 as the original citation for over capacity, is not a zero tolerance violation. LPA reviewed LIC421FC with Elizabeth and obtained signature. LIC421FC was generated as print only and a scanned copy will be maintained in the facility file.

During today's inspection, LPAs observed that the Assistant, Claudia, did not have criminal record clearance. A Livescan was completed on 5/4/2023 to obtain clearances, however the facility number was incorrectly inputted, resulting in no clearances associated to the day care home. A letter was generated by Guardian on 5/5/2023 requesting criminal record statement (LIC508) for Claudia. LPAs advised Elizabeth that Claudia will need to redo her fingerprinting. Upon review of Claudia's staff file, it was observed that she did not have proof of required immunizations, negative tuberculosis test, or Mandated Reporter training.

LPAs informed licensee, Elizabeth Gonzalez, that this report dated (9/27/2023) documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2023
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GONZALEZ, ELIZABETH
FACILITY NUMBER: 444406219
VISIT DATE: 09/27/2023
NARRATIVE
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Also, LPAs informed the licensee to provide a copy of this licensing report dated (9/27/2023) that documents any 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.

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

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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 09/27/2023 02:06 PM - It Cannot Be Edited


Created By: Cortney Nelson On 09/27/2023 at 01:21 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GONZALEZ, ELIZABETH
FACILITY NUMBER: 444406219

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/28/2023
Section Cited
CCR
102370(d)(1)

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102370 Criminal Record Clearance (d) All individuals subject to a criminal record review... shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption

This requirement was not met as evidenced by:
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The Licensee shall complete fingerprint clearances for Claudia and receive clearances prior to her presence in the day care home.
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The Licensee did not follow-up on criminal record clearances for Assistant, Claudia, who never obtained criminal record clearances due to incorrect facility number, which poses an immediate risk to the health, safety, and personal rights of children in care.
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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: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/27/2023 02:06 PM - It Cannot Be Edited


Created By: Cortney Nelson On 09/27/2023 at 01:26 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GONZALEZ, ELIZABETH
FACILITY NUMBER: 444406219

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2023
Section Cited
CCR
102369(b)(9)

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102369 Application for Initial License (b) The applicant shall provide all of the following information... (9) Evidence of a current tuberculosis clearance... for any adult in the home during the time that children are under care.

This requirement was not met as evidenced by:
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The Licensee shall obtain proof of negative tuberculosis test for her Assistant, Claudia, and submit to the Department by 10/11/2023.
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The Licensee did not obtain proof of a negative tuberculosis test for her Assistant, Claudia, which poses a potential risk to the health, safety, and personal rights of children in care.
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Type B
10/11/2023
Section Cited
HSC1596.8662(D)(3)

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1596.8662 (D)(3) On and after January 1, 2018, a person who becomes an administrator or employee of a licensed child day care facility shall complete the mandated reporter training... within the first 90 days that he or she is employed at the facility and shall complete renewal... every two years...

This requirement was not met as evidenced by:
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The Licensee shall have her Assistant complete Mandated Reporter training by 10/11/2023 and submit to the Department. LPAs advised that the training is available in Spanish via the online training at www.mandatedreporterca.com
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The Licensee did not have her Assistant, Claudia, complete mandated reporter training, which poses a potential risk to the health, safety, and personal rights of children in care.
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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: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/27/2023 02:06 PM - It Cannot Be Edited


Created By: Cortney Nelson On 09/27/2023 at 01:35 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GONZALEZ, ELIZABETH
FACILITY NUMBER: 444406219

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2023
Section Cited
HSC
1597.622(a)(1)

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1597.622(a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

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The Licensee will obtain proof of required immunizations (pertussis, measles, influenza) for her Assistant, Claudia, and submit to the Department by 10/11/2023. A signed declination for influenza is acceptable.
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The Licensee did not obtain proof of immunizations for her Assistant, Claudia, which poses a potential risk to the health, safety, and personal rights of children in care.
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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: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023


LIC809 (FAS) - (06/04)
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