Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192009044
Report Date: 08/27/2018
Date Signed 08/27/2018 03:14:48 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: 8DATE:
08/27/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Olivia GonzalezTIME COMPLETED:
03:30 PM
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REQUIRED - 3 YEAR INSPECTION CONDUCTED IN ENGLISH

A Required - 3 Year inspection was conducted by Licensing Program Analyst (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 four adults and no children. Upon arrival licensee was present with six children. Licensee's spouse arrived shortly after with an additional two children. Care is mainly provided in the day care space located to the right of the main entrance. Children use the bathroom in this area.

Children enter the activity space using the entrance leading from the backyard. Licensee's living room is used as additional napping space for infants. The remaining two bedrooms, bathroom, kitchen, and den are off limits to children in care. The front yard is off limits while the backyard is used for outdoor activity space. Licensee has a barricaded fireplace in the living room. There were no pets or accessible wall heaters observed. LPA observed an inaccessible detached shed in the backyard.

All rooms that are off-limits need to be made inaccessible during operating hours. 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: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2018
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: 08/27/2018
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There were no deficiencies cited in accordance with Title 22 of California Code of Regulations.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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. Required measles, pertussis, and influenza vaccinations were discussed.

Exit interview was conducted with licensee. Notice of site visit posted and Licensee was 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: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2018
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: 08/27/2018
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-Pediatric CPR and First Aid expires: 6/7/19
-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. www.mandatedreporterca.com.

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.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2018
LIC809 (FAS) - (06/04)
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