376614130-2-3-2023-20-CC-ECAA-CNPW5D-20230203155858

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376614130
Report Date: 02/03/2023
Date Signed: 02/03/2023 03:59:09 PM

Document Has Been Signed on 02/03/2023 03:59 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	GOMEZ, ANA ROSA FAMILY CHILD CARE		FACILITY NUMBER:	376614130
ADMINISTRATOR:	GOMEZ, ANA ROSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 662-0791
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92154
CAPACITY:	14	CENSUS: 3	DATE:	02/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Ana Rosa Gomez		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	On February 03, 2023 at 2:00 p.m., Licensing Program Analyst (LPA), Edgar Campana conducted an unannounced Annual Required Inspection and met with the Licensee, Ana Rosa Gomez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Three (3) daycare children were present in the facility during this inspection. An adult resident, who is cleared and associated was also present. This facility is a one story, three bedroom, 2 bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. Daycare areas includes: living room, dining room, family room, side patio, kitchen, hallway bathroom and back room addition (game room). The backroom addition is located next to the kitchen and is the main daycare room. Off limits areas includes: backyard, all bedrooms and garage. The fire extinguisher, type 3-A:40-B:C is operational and is located in the kitchen. The smoke detector and carbon monoxide detectors met requirements. All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. The home has a fenced side patio available for outdoor activities. Licensee’s First Aid and CPR certifications expire on 12/2024. Licensee has required immunizations. Mandated Reporter Training certificate expires on 06/2023. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 12/02/22. LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Edgar Campana	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GOMEZ, ANA ROSA FAMILY CHILD CARE	FACILITY NUMBER: 376614130
	VISIT DATE: 02/03/2023

NARRATIVE

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Licensee was also provided handouts with information regarding Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

Incidental Medical services (IMS) policy was discussed. 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.

No deficiencies cited during today's visit.

Exit interview conducted and report was reviewed with the licensee, Ana Rosa Gomez in Spanish. The following was provided to licensee: LIC809, Appeal Rights, and Notice of Site Visit. Licensee was advised that Notice of Site Visit must be posted for 30 days from today's visit.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Edgar Campana	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

LIC809 (FAS) - (06/04)

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