197417598-11-3-2023-30-CC-SGAA-CX8VAS-20231103161621

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197417598
Report Date: 11/03/2023
Date Signed: 11/03/2023 04:16:30 PM

Document Has Been Signed on 11/03/2023 04:16 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	GOMEZ FAMILY CHILD CARE		FACILITY NUMBER:	197417598
ADMINISTRATOR:	GOMEZ, BEATRIZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 834-0654
CITY:	WILMINGTON	STATE: CA	ZIP CODE:	90744
CAPACITY:	14	CENSUS: 3	DATE:	11/03/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Licensee, Beatriz Gomez		TIME COMPLETED:	02:00 PM

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On 11/03/2023 at 11:55am, Licensing Program Analyst (LPA), Sarah Garcia conducted an unannounced Annual Required Inspection at the above-mentioned facility. LPA was greeted by licensee, Beatriz Gomez. LPA observed adult in the home, Olimpia Vargas present during time of inspection.

During the initial inspection, LPA observed 3 children in care.

Facility operates Monday through Friday from 6:00 a.m. to 6:00 p.m. Currently licensee is available to care for children 0 years old and up. Facility is Large Family Child Care Home with a max capacity of 14. LPA observed the fire drill log. Licensee provides transportation to the children.

LPA toured the home inside and outside. The home is a single-family home with 2 bedrooms and 1 bathroom, the living room, kitchen area, outdoor area, and garage. Licensee confirmed the following areas are designated for day care only: living room, kitchen, outdoor area including garage. The bathroom that children use is located outside the kitchen. LPA inspected the bathroom and observed a safety latch under the sink to ensure medications, toxins or cleaning compounds are inaccessible to the children in care. LPA inspected the living room and observed the space to be clean and orderly. LPA observed mats and a play yard to be utilized for sleep. LPA observed the wall heater to be properly barricaded. LPA inspected the kitchen and observed the knives and sharp objects to be inaccessible to the children. LPA observed a safety latch under the kitchen sink cabinet to ensure all poisons, detergents, cleaning compounds, medications and other items which can pose a risk to children in care made inaccessible.

The following area is OFF LIMITS to the children in care: Bedroom #2.

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SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah Garcia	TELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GOMEZ FAMILY CHILD CARE	FACILITY NUMBER: 197417598
	VISIT DATE: 11/03/2023

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LPA inspected the outdoor area and observed safe toys and play equipment. Outdoor area is clean and free from debris. Per the licensee, there are no weapons or firearms on premises.

All electrical outlets were observed to be covered. LPA reminded licensee to ensure all areas that have been designated as OFF LIMITS need to have doors closed, locked, and made inaccessible when children are present.

LPA observed licensee test the carbon monoxide and smoke detector in the home. One charged fire extinguisher was observed, 2:A10:BC. Licensee confirmed program provides meals and snacks. LPA discussed the importance of maintaining a system where allergies and food restrictions are noted. LPA observed a first aid kit with band aids and a working thermometer.

Licensee currently does not administer medication. Adequate heating and ventilation for safety and comfort were observed in the space. The home has working telephone service and LPA confirmed the phone number (310) 834-0654.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

Capacity as specified on the license is being maintained during today’s inspection.

LPA reviewed 6 children’s files and observed (1) file to be incomplete. LPA observed 1 out of 6 files was missing an immunization record. LPA issued a Type B citation. LPA discussed all necessary forms needed in each children’s file and provided licensee with the LIC 311D- Records to be maintain in the facility and provided licensee with a current copy to use as a reference when auditing files. LPA reviewed Licensee’s Pediatric CPR and First certification and observed certification with an expiration date of 3/2025. Licensee’s Mandated Reporter training certificate was expired and LPA instructed licensee to renew and send a copy of certificate via email to sarah.garcia@dss.ca.gov by 11/06/2023 by 5pm. LPA advised the mandatedreporterca.com

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SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah Garcia	TELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GOMEZ FAMILY CHILD CARE	FACILITY NUMBER: 197417598
	VISIT DATE: 11/03/2023

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 licensee 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.

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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Beatriz Gomez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah Garcia	TELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GOMEZ FAMILY CHILD CARE	FACILITY NUMBER: 197417598
	VISIT DATE: 11/03/2023

NARRATIVE

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A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report along with appeal rights was reviewed with the licensee.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809D) Licensee was provided with a copy of appeal rights.

LPA Sarah Garcia informed licensee Beatriz Gomez that this report dated 11/03/2023 document(s) (1) Type B citation which shall be posted for 30 consecutive days as there is a potential risk to the health, safety, or personal rights of children in care. Also, LPA Sarah Garcia informed the licensee to provide a copy of this licensing report dated 11/03/2023 that documents any Type B citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah Garcia	TELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 11/03/2023 04:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GOMEZ FAMILY CHILD CARE	FACILITY NUMBER: 197417598
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee does not have immunization record for 1 out of the 6 children's files which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/06/2023
	Plan of Correction
1 2 3 4	Licensee will send LPA a copy of the chid's immunization record via email to LPA at sarah.garcia@dss.ca.gov by 11/06/2023 on 5pm.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah Garcia	TELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC809 (FAS) - (06/04)

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