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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216522
Report Date: 02/08/2023
Date Signed: 02/08/2023 11:30:18 AM

Document Has Been Signed on 02/08/2023 11:30 AM - 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ROSAS & ISLAS GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
566216522
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
02/08/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Rosa RosasTIME COMPLETED:
11:47 AM
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On February 8, 2023 at 9:00 AM, Licensing Program Analyst (LPA) Susana Martinez made an announced Pre-licensing Inspection. LPA met with applicant Rosa Rosas and advised her of the reason for the inspection. Together with the applicant, LPA toured the home inside and outside. At the time of the inspection there was one child present (applicants own) along with applicants husband (assistant). Applicant denies having guns and ammunition in the home.

No bodies of water were observed at the time of inspection. The single-story home has 3 bedrooms, kitchen, living room, 1 bathroom, and an enclosed backyard. The applicant will be using the kitchen, living room, bathroom, backyard and room closest to the living room for day care. LPA observed a regulatory 2A10BC fire extinguisher located in the kitchen with receipt showing purchase date of 1/26/23. A dual smoke and carbon monoxide detector is located in the living room. Additional smoke and carbon monoxide detectors are located in the hallway. The main room that will be used for day care was observed to be free of toxins/hazardous items. Age-appropriate toys and learning materials were observed inside the room. LPA observed a first aid kit located in the living room. The required posting requirements will be placed on a cork board located in the living room which will be easily accessible by parents/guardians.

The backyard is fully enclosed and contains artificial turf. LPA observed a garage behind the fence, applicant states it is empty and she has no access to it. Applicant states the landlord plans on renting the garage to someone in the future. LPA advised the tenant(s) need to be fingerprinted and cleared prior to moving onto the premises. Applicant states they have made the landlord aware of the requirement and will follow through.

The kitchen was observed to be clean and free of toxins/hazardous items. All kitchen cabinets were observed to have locks on them, making it inaccessible for children to reach the knives and cleaning supplies. Applicant states she plans on cooking for the children in care, and plans on creating a weekly menu for the parents to view. LPA advised to be cognizant of possible food allergies that children might have.

Continued on 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2023
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ROSAS & ISLAS GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 566216522
VISIT DATE: 02/08/2023
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Licensee's Pediatric First Aid/CPR certificate is valid through 8/8/2024. Licensee was reminded to renew her certification every two years. Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com

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 receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

Continued on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ROSAS & ISLAS GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 566216522
VISIT DATE: 02/08/2023
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LPA advised the applicant to sleep infants where they can always be directly supervised. LPA also advised against sleeping infants in a separate room.

LPA advised No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority.



Entrance Checklist was provided to the applicant.

The home meets Title 22 Division 12 requirements of a Small FCCH. Effective date of license is today, February 8, 2023. Once licensed, the applicant is required to comply with the terms and limitations stated on the license.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee Rosa Rosas.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC809 (FAS) - (06/04)
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