304312270-8-16-2023-06-CC-PRIS-CURUTY-20230816155242

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304312270
Report Date: 08/16/2023
Date Signed: 08/16/2023 03:52:47 PM

Document Has Been Signed on 08/16/2023 03:52 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	GOMEZ, LAURA SILVIA		FACILITY NUMBER:	304312270
ADMINISTRATOR:	GOMEZ, LAURA SILVIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 923-9182
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92840
CAPACITY:	14	CENSUS: 12	DATE:	08/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Laura Silvia Gomez, Licensee		TIME COMPLETED:	04:00 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	Licensing Program Analyst (LPA) P Rivas conducted an unannounced annual inspection and met with Licensee Laura Silvia Gomez. Upon entrance LPA observed 12 children in care and two assistants. Two of the children were infants, 2 which were school age and 8 pre school children. Hours of operation are 7:00am to 6:00 pm Monday through Friday. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are 3 adults and 1 minor child which includes the licensee living in the facility per licensee. During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to childcare children. Off limits areas which were accessible during LPAs visit were also observed. The off limit areas that were currently available to children included two bedrooms and converted garage. The master bedroom was not observed as this room was locked and inaccessible. LPA advised to obtain child proofing items. Including but not limited to; baby looks, door knob covers. The childcare area consists of living room, converted dining area, 1 bathroom that is located down the hall on the left side. There is an outside covered patio area that is also used as children's day care area. There are working carbon monoxide, smoke detector, and fire extinguishers in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Licensee stated there are no firearms and/or other dangerous weapons in the facility, and none were observed during today's inspections. Licensee stated there is no smoking allowed in the home. The facility does not have a fireplace. The home has age-appropriate toys for the ages served. LPA verified there is a working telephone service (cellular service). Licensee stated, they use an enclosed back patio for outdoor play, LPA inspected the back patio and found to be in compliance. cont. page 2

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GOMEZ, LAURA SILVIA	FACILITY NUMBER: 304312270
	VISIT DATE: 08/16/2023

NARRATIVE

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Outside backyard was observed and found a pool. LPA observed a 5ft fencing around the pool. The gate was observed to be in good repair, properly installed and completely surrounded the pool. The gate is at least 5 feet high and is not climbable by children. LPA Rivas verified the gate swings away from the pool and is self-latching. There are two french doors that lead into outside covered patio area, after which the backyard including the pool is situated. The doors have door chimes. The bodies of water is inaccessible to children in care.

Due to time constrains the annual inspection will be continued at a later date.

No deficiencies were cited during today's inspection.

An exit interview was conducted with licensee, Laura 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 to 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.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

LIC809 (FAS) - (06/04)

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