136610199-3-3-2020-20-CC-GGOZ-BMCV3C-20200303150432

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 136610199
Report Date: 03/03/2020
Date Signed: 03/03/2020 03:04:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	GOMEZ, MARIA FAMILY CHILD CARE		FACILITY NUMBER:	136610199
ADMINISTRATOR:	MARIA GOMEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 890-5143
CITY:	CALEXICO	STATE: CA	ZIP CODE:	92231
CAPACITY:	14	CENSUS:	DATE:	03/03/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Maria Gomez		TIME COMPLETED:	03:15 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	On March 3, 2020, at 12:15 p.m., Licensing Program Analyst's (LPA's), Gloria Gonzalez and Michelle Palacio conducted an unannounced Required - 1 Year Inspection and met with the Licensee, Maria Gomez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Seven (7) children and one (1) staff were present in the facility during this inspection. This facility is a one story, 4bedroom, 2 bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for childcare are: Kitchen, dining room, living room and bathroom . Off limits areas are bedroom 1,2,3 and 4 and are inaccessible through use of door knob and locks. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. The home has a fenced backyard available for outdoor activities. There are no bodies of water. Licensee stated there are no weapons in the home. A review of staff records on this date indicates that not all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances. At 12:20 LPA observed helper, Jessica Gamiz, caring for 3 children in the back yard. After interview with Licensee and helper it was fount that Jessica Gamiz is not fingerprint cleared. Licensee’s First Aid and CPR certifications expire on 11/2020. Licensee has required immunizations. Licensee is currently exempt from Mandated Reporter Training. 4 of 7 children’s records were reviewed and contain immunization documentation and Notification of Parent’s Rights form. LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria Gonzalez	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GOMEZ, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 136610199
	VISIT DATE: 03/03/2020

NARRATIVE

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Incidental Medical services (IMS) policy was discussed. Licensee stated that some of the children have used nebulizers. Advised needs IMS plan. Advised has 30 days to submit an IMS plan. 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.

California Code of Regulations, Title 22, Division 12 102370(d)(1)), are being cited on the attached LIC 809-D.

Deficiencies are being cited based on LPA observation in accordance with the California Code of regulations, Title 22 see LIC809D. Violations regarding the criminal record clearance was not met.

Plans of Corrections were reviewed and developed with the Licensee. A Copy of this report and appeal rights were discussed and left with the Licensee, Maria Gomez, whose signature on this form confirm receipt of these document.

Upon Receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria Gonzalez	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GOMEZ, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 136610199
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/03/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/03/2020 Section Cited	1 2 3 4 5 6 7	All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working...in a licensed facility: (1) Obtain a California clearance...as required by the Department. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on observation and interview, the Licensee did not ensure that Staff #1 had obtained a criminal record clearance prior to working in the facility which poses an immediate risk to the safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria Gonzalez	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2020

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

LIC809 (FAS) - (06/04)

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