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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010065
Report Date: 05/19/2021
Date Signed: 08/27/2021 05:27:21 PM

Document Has Been Signed on 08/27/2021 05:27 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:DAVILA, LESLIE & GONZALES, GLADYS FCCHFACILITY NUMBER:
493010065
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
05/19/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Leslie Davila and Gladys GonzalezTIME COMPLETED:
05:20 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
A Facetime video conference (change of location) Pre-Licensing inspection was conducted today by Licensing Program Analyst (LPA), Leticia Rosales-Meza. The applicants are Spanish Speaking. Due to the COVID-19, the Department has suspended all field operations, and the applicants agreed to attend the Tele-Inspection conference with LPA. The applicant was previously licensed at 2764 Desert Rose Lane, Santa Rosa, CA 95407. The applicants are requesting a license for a capacity of 8 children. Services will be provided Monday - Friday 5:00 AM - 7:00 PM. The applicants understands that 24hr consecutive care is prohibited. The applicants understand that childcare must be provided in the "primary" residence of the applicants. The residence is a two story level four bedrooms, two in a half bath home. There are three adults living in the home. Applicants were advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The applicants are aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance.

During the Tele-Inspection, the applicants provided a virtual tour of the entire facility and backyard. The day care areas will be the first floor of the home, specifically, living room, dining room, kitchen and downstairs half bathroom. The second floor, laundry room, and garage are "off limits" to the day children, and were made inaccessible by a secured gate, door knob covers, and key locked doors. The floor plan submitted by the licensee was reviewed and verified. During the video LPA observed electrical outlets were covered and drapery cords are not accessible. The home appears to be clean and orderly at this time and will remain so during child care hours. There is a working telephone in the home. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The applicants stated there are no Firearms or Weapons, and none were observed during today's Tele-Inspection. Applicants stated there are no poisons in the home. The requirement that poisons be stored in a space locked with a key lock/combination lock is reviewed. First Aid supplies are kept in the entry closet. The fireplace has been made inaccessible with a screen. Mrs. Davila states does not use the fireplace at all.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: DAVILA, LESLIE & GONZALES, GLADYS FCCH
FACILITY NUMBER: 493010065
VISIT DATE: 05/19/2021
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
The children will use the backyard and patio as the outdoor play and is fully fenced. No bodies of water were observed during the video inspection. There is no trampoline, pool, pond, or fountain observed during today's Tele-Inspection. Pediatric CPR and Pediatric First Aid cards expire on 05/2021. All licensing reports are public information and must be made available upon request for at least three years.

Based on this video inspection, the facility meets licensing requirements. The license is granted and is now licensed as a Small Family Child Care Home.

The Applicant's signature was not recorded on this Facility Evaluation Report (LIC 809 & LIC 809-C), however, the Applicant was provided with a copy of this report; and the Applicant's proof of Read Receipt is on file. LPA also mailed a copy of this report to the Applicant.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2