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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628311
Report Date: 08/14/2019
Date Signed: 08/14/2019 03:34:50 PM

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, ERIKA & QUINONEZ, RAQUEL FAMILY CHILD CAREFACILITY NUMBER:
376628311
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
08/14/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Licensee Erika GomezTIME COMPLETED:
03:45 PM
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Licensing Program Analysts Joelle Redding and Elizabeth Rivera made an unannounced visit to evaluate the facility for a requested increase in capacity. The request was received on 7/3/19 and the fire clearance was received on 7/23/19.

LPAs toured the home. There have been no changes since licensure in May. There is a cover for the outdoor air conditioning unit. No hazards were noted. The carbon monoxide detector, mounted on the wall by the kitchen, is operational. The smoke alarm, by the entrance at the base of the stairs is operational and the Fire extinguisher is full, of adequate size and mounted near the front door. All required documentation is posted. A sample of children's records were reviewed and the child care roster is current.

Both Licensee's have current pediatric First Aid/CPR certification. Capacity limitations were discussed and Licensee understands that she may not operate at a large license capacity without an assistant. It is to be noted that Licensee Erika Gomez has prior teacher experience in a Community Care Licensed child care center. Effects of Lead Exposure handout was provided for dissemination to parents/guardians of children in care.

The request for an increase in capacity from a small family home to a large family home is granted. An updated license will be sent for posting.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
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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