Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192009044
Report Date: 10/09/2015
Date Signed 10/09/2015 12:58:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
192009044
ADMINISTRATOR:GONZALEZ, OLIVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 406-1032
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 3DATE:
10/09/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Olivia GonzalezTIME COMPLETED:
01:15 PM
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ANNUAL/RANDOM VISIT CONDUCTED IN ENGLISH

(3)An Annual Random visit was conducted by LPA Timothy Fields. LPA was guided on a tour of the facility by Licensee Olivia Gonzalez. This is a single story home with three bedrooms and two bathrooms. Residing in the home are two adults and two children ages 17 and 15. Licensee's husband and assistant was present with 3 children during todays visit. Care is provided in the master bedroom which has been converted to the day care room. The day care room also contains a bathroom utilized by the children.

The family room is used for additional activity space. The kitchen, den, and remaining two bedrooms and guest bath are off limits. The backyard is used for outdoor activity space while the front yard is off limits. LPA observed a detached shed and other miscellaneous isolated from the play space. Their is a gate separating the two areas. LPA observed a barricaded fireplace in the family room. There were pets or wall heaters observed in the home. LPA did not observe any children in a locked car.

All rooms that are off-limits need to be made inaccessible during operating hours. The garage can only be utilized as activity space. There is no eating or sleeping permitted in the garage. Storage areas for poisons, detergents, cleaning compounds, medicines, and other items which pose a danger to children were observed to be inaccessible to children in care. LPA observed the home to be kept clean and orderly, with heating and ventilation for safety and comfort. Capacity and ratio was observed to be in compliance. Licensee complied with inspection authority.

Per licensee there are no weapons or firearms in the home. Telephone service was in operable condition. There are no *swimming pool or spa on the premises. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors, Carbon Monoxide detector, and fire extinguisher (2A 10BC) are in operable condition.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2015
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009044
VISIT DATE: 10/09/2015
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The following was discussed: Individuals who are 18 years of age or older living or working in the home must be finger print cleared prior to licensure or living/working in the facility. Individuals within one month of their 18th birthday must be fingerprinted immediately. An immediate $100 per day Civil Penalty for a maximum of five days for the first violation and a maximum of 30 days for subsequent violations per individual will be issued. If an individual has a clearance with the Department, a criminal record clearance may be transferred. LIC 9182 Criminal Background Clearance Transfer Request may be used.

During operating hours no smoking, no infant walkers, Johnny jumpers, Exersaucers and any other item that falls into that category are allowed in the facility. Earthquake, fire disaster, and safety drill posting requirement were explained in detail on this date.

Licensee has been advised of the following:.
.Pools should be inaccessible by a pool cover or a 5-foot fence around the perimeter of the pool. If the fence is made out of chain link, the opening should not allow a golf ball to pass through. Fences made out of mesh will need to be approved by the department. Mesh fence will remain in place whenever licensed care is provided, and as long as the mesh fence makes the swimming pool inaccessible to children as determined by licensing staff.
· Pool cover label should read F1346-91 American Society for Testing Material and it should be able to withstand the weight of an adult without water above cover when standing.
·Dog(s) and or pets should be isolated from children in care.
·It is recommended that a First Aid kit be available on premises.
Outdoor supervision required at all times. If outdoor area not adequately fenced provider must be with children at all times when outdoors.

-CPR and First Aid expires 8/24/17
-Child Care Roster, Disaster Plan, and Children's Records were discussed.
-Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2015
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009044
VISIT DATE: 10/09/2015
NARRATIVE
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There were no deficiencies cited in accordance with Title 22 of California Code of Regulations.

Exit interview was conducted with licensee. Appeal rights and procedures explained.

Site visit notice posted. And Licensee advised to keep notice posted for 30 days.
Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2015
LIC809 (FAS) - (06/04)
Page: 2 of 3