376626037-3-16-2020-10-CC-LEDS-BMRN9G-20200316101554

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376626037
Report Date: 03/16/2020
Date Signed: 03/16/2020 10:16:08 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	GOMEZ, SILVIA FAMILY CHILD CARE		FACILITY NUMBER:	376626037
ADMINISTRATOR:	SILVIA GOMEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 453-3302
CITY:	VISTA	STATE: CA	ZIP CODE:	92083
CAPACITY:	14	CENSUS: 2	DATE:	03/16/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	Silvia Gomez-Licensee		TIME COMPLETED:	10:30 AM

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	(3) On March 16, 2020 at 9:13am, Licensing Program Analysts (LPA’s) La Kesha Edwards and Patricia Berry arrived at the facility to conduct a Required – 1 year inspection as part of a compliance review and met with Licensee, Silvia Gomez. LPA’s disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Licensee accompanied LPA’s inside and out of the facility during the inspection and the following was observed and/or discussed: Normal days and hours of operation are: Monday through Friday, 7:00am to 5:30pm OFF-LIMIT AREAS INCLUDE: Garage and 2^nd floor · The licensee is present in the home and ensures that children in care are supervised at all times · The licensee is operating within the licensed capacity and ratios · Fire extinguishers, smoke detectors, and carbon monoxide detectors meet State Fire Marshall standards and were tested by the applicant during this inspection. · Fireplaces and open face heaters are screened to prevent access by children · Where children less than five years old are in care, stairs are fenced or barricaded · Storage areas for poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children · All poisons are locked · Storage areas for firearms and other dangerous weapons are inaccessible to children, and locked · Ammunition is stored and locked separately from weapon(s) LICENSEE UNDERSTANDS ALL GUNS, WEAPONS AND AMMUNITION MUST BE KEY-LOCKED SEPARATELY AND MADE INACCESSIBLE PER TITLE 22 REGULATIONS. · The home is kept clean and orderly, with heating and ventilation for safety and comfort

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha Edwards	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2020

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: GOMEZ, SILVIA FAMILY CHILD CARE	FACILITY NUMBER: 376626037
	VISIT DATE: 03/16/2020

NARRATIVE

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·Each child has safe, healthful, and comfortable accommodations, furnishings, and equipment
· The home provides safe toys, play equipment, and materials
· All pools, spas, hot tubs, fish ponds, or similar bodies of water are made inaccessible to children by covering or fencing as specified by regulation. LICENSEE UNDERSTANDS ALL BODIES OF WATER INCLUDING PONDS, ABOVE GROUND POOLS & SPAS, IN-GROUND POOLS & SPAS, AND SOME FOUNTAINS MUST BE PROPERLY COVERED OR FENCED PER TITLE 22 REGULATIONS. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· The home has a current roster of children
· The home conducts fire and disaster drills, last drill conducted on 2/3/2020
· Licensee documents immunizations and maintains and updates records for children in care
· Licensee provides the child's parent or representative with a copy of the Family Child Care Home Notification of Parents' Rights
· The licensee and other personnel, as specified, have completed training on preventive health practices which was completed on 8/2/16; including pediatric CPR and First Aid which expires 7/2020 for Veronica Hernan (Assistant) and 12/2022 for Silvia Gomez (licensee).
· Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed. Resident and/or staff records reviewed on 3/16/2020 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations858@dss.ca.gov
· The licensee understands that upon notice of the Department to remove an individual from the home, pursuant to H&S Code 1596.871(c)(2), or to exclude an individual from the home, pursuant to H&S Code 1596.8897, the licensee immediately removes the individual and prevents them from returning to the home or having contact with children in care
· Children are not left in parked vehicles and the licensee understands that this is prohibited

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha Edwards	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2020

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: GOMEZ, SILVIA FAMILY CHILD CARE	FACILITY NUMBER: 376626037
	VISIT DATE: 03/16/2020

NARRATIVE

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·The licensee understands that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
· Incidental Medical Services (IMS) policy was discussed. Facility is not providing IMS at this time. 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
· For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Risk-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

- Access to forms & Regulations for Family Child Care Homes online at www.ccld.ca.gov
- Responsibility to know the regulations for anyone providing care
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility’s phone numbers must be on file at all times.
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months
- Responsibilities of being a mandated reporter

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha Edwards	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2020

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: GOMEZ, SILVIA FAMILY CHILD CARE	FACILITY NUMBER: 376626037
	VISIT DATE: 03/16/2020

NARRATIVE

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- Baby walkers, bouncy seats, exersaucers and other similar items are prohibited
- The applicant is urged to visit the U.S. Consumer Product Safety Commission webpage at www.cpsc.gov to ensure that equipment purchased for the day care has not been recalled
- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
- Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov.
- Please email: childcareadvocatesprogram to receive Department updates. They will be sent directly to your e-mail account once you have set up an account. This website can also be accessed through www.ccld.ca.gov
- The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

See LIC809D for cited deficiencies.
Appeal rights discussed and a copy of this report was provided to the licensee on this date.

During the exit interview, the LICENSEE, Silvia Gomez, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279, LIC508 and TB Screen and have your child submit for LIVESCAN background clearance. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.

A copy of this report was provided to the licensee on this date and must be made available to the public upon request for the next 3 years.

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha Edwards	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2020

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: GOMEZ, SILVIA FAMILY CHILD CARE	FACILITY NUMBER: 376626037
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/16/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/16/2020 Section Cited	1 2 3 4 5 6 7	102417(3) Operations of A Family Child Care Home: (3) Where children less than five years old are in care, stairs shall be fenced or barricaded. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on observations, during inspection of the facility, the licensee did not have the stairs barricaded and has 2 children in care that are under the age of 5. This poses an potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
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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: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha Edwards	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2020

LIC809 (FAS) - (06/04)

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