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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700448
Report Date: 02/25/2022
Date Signed: 02/25/2022 01:31:55 PM


Document Has Been Signed on 02/25/2022 01:31 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:GOMEZ-CASTILLEJOS FAMILY CHILD CAREFACILITY NUMBER:
197700448
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
02/25/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Licensee Monica Gomez-CastillejosTIME COMPLETED:
01:40 PM
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On February 25, 2022 at 11:55AM, Licensing Program Analyst (LPA) Brigitte Tsutaoka conducted a Case-Management Licensee Initiated inspection to increase capacity from a Small Family Child Care Home (FCCH) (8) to a Large FCCH (14 with parent approval). LPA disclosed the purpose of inspection and was granted entry by Licensee, Monica Gomez-Castillejos, who guided LPA on a tour of the facility. Upon entry LPA, observed 2 children in care eating lunch. Children moved to family room after lunch and played on their tablets. LPA observed children wearing masks. The operating hours are Monday through Saturday, 5:00 AM-7:00 PM.

This is a single story home with 3 bedrooms, 2 bathrooms, kitchen, living room, dining room, family room, and garage. There is no pool/spa or body of water on the premises. Per Applicant, the following areas are utilized for Family Child Care: living room, family room, and Bedroom #2. The facility backyard is completely fenced, from the front yard to the backyard. The off-limits areas include: bedrooms #1 and #3, laundry room, and the garage. The fireplace is screened, fastened securely to wall and inaccessible to children. The cleaning solutions (locked under kitchen sink) and medications (in off-limits bedroom) are stored inaccessible to children. The knives are kept in a top kitchen cabinet in plastic container, inaccessible to children. Per the licensee there are no weapons or firearms of any kind in the facility. LPA did not observe any weapons at this time.

The smoke and carbon monoxide detectors are in operable condition. The licensee was reminded that fire and disaster drills are to be conducted at least once every six months and logged. The home had the required fire extinguisher (2A10BC) that meets State Fire Marshal standards (reading in green).
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GOMEZ-CASTILLEJOS FAMILY CHILD CARE
FACILITY NUMBER: 197700448
VISIT DATE: 02/25/2022
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The facility's annual fees are current. The licensee had all the required licensing documents posted in the day care room visible to parents. LPA observed a current child roster. The outside back yard is used by the children for outside play (shaded area provided in gazebo in center of yard). The back yard is gated all around. The outdoor play area was inspected and was observed to be free of hazards, loose and sharp parts. The outdoor play structure is anchored to the ground and located on soft sand used as cushioning material.
The licensee was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your Analyst of any person who will be visiting regularly or for longer than one week. Licensee is aware all adults over the age of 18 years must be fingerprint cleared visiting regularly or for longer than one week.
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

The licensee was reminded it is her responsibility to visit the department's website to obtain licensing forms, Quarterly Updates, and Provider PINs.

Fire clearance was granted on 02/17/2022 for a large FCCH with a maximum capacity of 14 children in care. Licensee is aware a qualified criminal record cleared adult is required when more than 8 children are present. A capacity for a large FCCH has been approved with maximum 14 children in care effective today 2/25/2022.
An exit interview was conducted. A copy of this report, Appeal Rights and Notice of Site were provided to Licensee, Monica Gomez-Castillejos.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022
LIC809 (FAS) - (06/04)
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