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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426210992
Report Date: 01/31/2020
Date Signed: 01/31/2020 11:11:03 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GOMEZ FAMILY CHILD CAREFACILITY NUMBER:
426210992
ADMINISTRATOR:MARIA RAQUEL GOMEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 693-0768
CITY:LOS OLIVOSSTATE: CAZIP CODE:
93441
CAPACITY:14CENSUS: 1DATE:
01/31/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Maria Raquel GomezTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Ruth Gull made an unannounced RANDOM ANNUAL inspection to the home. Met with Licensee Maria Raquel Gomez and explained the purpose of the inspection. There was 1 child present. A tour of the home was made both inside and outside. The licensee uses the play room (in the front area of the home) and a hall bathroom for the day care. Another room is used for napping. The living room, dining room area, bedrooms and kitchen area are accessible to children. LPA did not observe any toxins/ hazardous items accessible to children. The regulation fire extinguisher was purchased on 09/2019. Licensee was reminded the fire extinguisher needs to be serviced or replaced yearly. The smoke detector and carbon monoxide detector were tested and observed to be functioning. The Licensee uses the back yard for the day care. Because the yard is not completely enclosed by fencing, Licensee supervises the children when they are outside. LPA reviewed a sampling of children's records. Licensee's American Red Cross Pediatric First Aid/CPR certificates are valid through 12/20/21. Licensee's AB 1207 Mandated Reporter certificate is current. Licensee states that there are not any guns/weapons on the property.
Incidental Medical Services (IMS) policy was discussed. 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

Licensee is reminded that they are responsible for knowing the regulations for a Family Child Care Home and that Licensing information can be accessed online at www.ccld.ca.gov. LPA reviewed and provided Licensee with Guide to Infant Safe Sleep and Effects of Lead Exposure pamphlet (to be provided to all current and future parents).

No deficiencies were cited in areas inspected today. The LIC 9213 (Notice of Site visit) was posted.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020
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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