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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013619
Report Date: 09/26/2023
Date Signed: 09/26/2023 11:22:52 AM


Document Has Been Signed on 09/26/2023 11:22 AM - 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. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:GOMEZ & URQUIZA FAMILY CHILD CAREFACILITY NUMBER:
198013619
ADMINISTRATOR:GOMEZ,IRMA&URQUIZA, ASHLEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 272-9752
CITY:WEST COVINASTATE: CAZIP CODE:
91790
CAPACITY:14CENSUS: 6DATE:
09/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Irma Gomez & Ashley UrquizaTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Cynthia Reyes conducted an unannounced annual inspection on this date. This inspection is to ensure the health and safety standards as required by the regulations governing child care homes are met. LPA met with Irma Gomez & Ashley Urquiza, Licensees. A copy of the Entrance Checklist for Child Care homes form (LIC 126) was provided. The facility operating hours are from Monday through Friday 5:30 AM-10 PM. A covid risk assessment was conducted upon entry. Individuals residing in the home are the licensee Irma and Ashley, and spouse of Irma.

The home is a single story home, with 3-Bedrooms, 1-Bathroom. The following areas are used for day-care: Kitchen, living room, dining room, 1 bedroom, 1 bath room, and back yard. Off limit areas include: Front Yard, Garage and 2 Bedrooms. **Rooms that are off-limits need to be made inaccessible during operating hours** The Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

First Aid/CPR certificate for licensees exp. on 03/05/2025 & 02/24/2025. Husband taken on 02/27/2025.

Detergents and cleaning supplies were observed inaccessible to children. The home has electrical outlet covers throughout and maintains a First Aid Kit with the required supplies. There are adequate age appropriate toys, books, and games. There are no firearms present on the premises as stated by licensee. There are no pools or spas, or other bodies of water. Currently there is no dogs and no other pets.

LPA observed the home to be clean and orderly. There are toys available for children. Appropriate sleeping equipment and arrangements



LPA advised the licensee how to access forms and regulations on line at: www.ccld.ca.gov.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023
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. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOMEZ & URQUIZA FAMILY CHILD CARE
FACILITY NUMBER: 198013619
VISIT DATE: 09/26/2023
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Licensing staff observed the following required posted documentation in the front entrance: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form. LPA reviewed facility records for LIC 9040- Facility Roster and LIC 610- Facility Disaster Plan.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, and made inaccessible to children. Isolation area for sick children waiting to be picked up is in the one accessible bedroom and other children will be away from the sick child in the living room.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, A current children’s roster was available for review with 14 children enrolled.

Staff records were reviewed, LPA reviewed the LIC 508- Criminal Record Statement. Both Licensees have Proof of immunization's against measles and TDAP. Influenza declination is on file, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and Mandated Reporter Training Certificate are current and on file for both licensee's. Taken on 08/10/2023

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/.

The department has On Duty Workers available for questions Monday through Friday at (323) 981-3350 from 8:00 AM - 5:00 PM
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOMEZ & URQUIZA FAMILY CHILD CARE
FACILITY NUMBER: 198013619
VISIT DATE: 09/26/2023
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The following was observed and reviewed during this inspection. All areas identified on the facility sketch were inspected for safety, comfort, and cleanliness. There is telephone service via a land line and a cellphone that stays at the facility during operation hours. There is ventilation and heating. Detergents, cleaning compounds, and medications were observed to be inaccessible to children. The restroom that children use was observed to be safe and sanitary

LPA Reyes observed the valve on the required 2A10BC fire extinguisher indicates fully charged. Per observation of tag date is 02/28/2023 and needs to be serviced. Smoke detector and carbon monoxide was tested and is operable. LPA advised that all Small family day care homes shall conduct fire and disaster drills at least once every 6 months and a large day care is every 3 months, and document the date and time of each drill. Last drill conducted and documented on 08/15/2023. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted on the parent board and visible to parents and all to see.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.


LPA did not observe any objects that can pose a danger to children in care. The licensee is observed to be operating within the license capacity limitations.

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/process.

Report continues on next page

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOMEZ & URQUIZA FAMILY CHILD CARE
FACILITY NUMBER: 198013619
VISIT DATE: 09/26/2023
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AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com. Licensee took on 04/19/2023.

Criminal Record Clearance: 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.

Infant Care: 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-andresources/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.

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.



There are no deficiencies being cited on this date. LPA provided consultation during this inspection. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Irma Gomez, Licensee.

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

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4