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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310791
Report Date: 09/01/2023
Date Signed: 09/01/2023 11:19:52 AM


Document Has Been Signed on 09/01/2023 11:19 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:GOMEZ-ZUNIGA, INESFACILITY NUMBER:
304310791
ADMINISTRATOR:GOMEZ-ZUNIGA, INESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 606-3913
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92672
CAPACITY:14CENSUS: 7DATE:
09/01/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:GOMEZ-ZUNIGA, INESTIME COMPLETED:
12:00 PM
NARRATIVE
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LPA CONDUCTED A PROOF OF CORRECTION VISIT AS A FOLLOW-UP TO AN ANNUAL VISIT CONDUCTED ON 6/14/2023 .

LPA met with licensee GOMEZ-ZUNIGA, INES. LPA stated the purpose of the visit and request a facility roster, infant 15-min checks, and 1 infant file.

During the visit a census was request. 7 children - 4 of 7 were under the age of 2 years and 3 were over the age of 2. The licensee had 1 cleared assistant present.

LPA tour the living room that was observed to have 7 children and the dining room that has children's bedding set up at 10:09 am.

Upon request of 15 minute check the licensee stated she did not have Sleep Logs for 3 of 4 infants present. A consultation was provided for best practice of ensuring she is staying within ratio.

During today’s inspection, the licensee and LPA discussed the following:

- Stay up to date with LIC 9227 and discuss with parents any new changes


- Ensure 15 min checks are conducted & logged (The initial of the person checking should be included)
- 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.
- Always place infants on their backs to sleep
- Use only a tight-fitting sheet on the crib or play yard mattress
- Do not hang any items from the crib or above the crib
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GOMEZ-ZUNIGA, INES
FACILITY NUMBER: 304310791
VISIT DATE: 09/01/2023
NARRATIVE
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- Keep all items, including blankets, out of the crib or play yard
- Pacifiers may be used if they do not have items attached to them
- Infants should not be swaddled or have any items covering them while sleeping
- The room's temperature should be comfortable enough for an adult to wear a T-shirt and not be too hot or cold.

Child Care Licensing Program Webinars: The Child Care Licensing Program is pleased to continue offering webinars to share important information with the child care licensing community in 2023.
2023 Webinar Schedule

• Tuesday, September 26, 2023, 6:00 p.m.
• Tuesday, December 12, 2023, 6:00 p.m.
To register for webinars, see Provider Information Notice (PIN), PIN 22-30-CCP. Providers may wish to view previously recorded webinars.

Heat Precautions in Child Care: Health and age play a significant role in how people react to extreme heat. Individuals at most significant risk for heat-related illness include infants and children up to four (4) years of age. By knowing how to prepare for a heat wave, and what to do when one occurs, you can avoid the biggest health dangers, such as heat exhaustion and heat stroke. Before sending children out to play, adequate supervision is required and staff need to know how to protect them against heat-related illness. Providers must meet the requirements of the applicable., and California Code of Regulations, Title 22, Division 12. Have a safe, healthy, and enjoyable summer!

The licensee understands they must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care for and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/01/2023 11:19 AM - 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: GOMEZ-ZUNIGA, INES
FACILITY NUMBER: 304310791

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/01/2023
Section Cited
CCR
102425(j)(2)

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(j) The provider shall supervise infants while they are sleeping and adhere to the following requirements: (2)The provider shall check and document the following:Based on LPA's observation, and licensees interview, the licensee did ot comply with the section cited above bymeans of stating she did not have
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The licensee stated she will start doing infant sleep logs starting today when the children take their nap.
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sleep logs for 3 of 4 infants present during today's visit which poses animmediate health, safety or personal rights risk to children in care. LPA provided a in dept consultation on 6/14/2023 annual inspection.
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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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GOMEZ-ZUNIGA, INES
FACILITY NUMBER: 304310791
VISIT DATE: 09/01/2023
NARRATIVE
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 The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed, and cited at the time of the visit.

The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: 102425(j)(2)

An exit interview was conducted with Ines Gomez. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First-level appeals should be sent to the regional manager at the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

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

End of Report.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
LIC809 (FAS) - (06/04)
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