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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426210992
Report Date: 12/30/2024
Date Signed: 12/30/2024 12:50:42 PM

Document Has Been Signed on 12/30/2024 12:50 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GOMEZ FAMILY CHILD CAREFACILITY NUMBER:
426210992
ADMINISTRATOR/
DIRECTOR:		MARIA RAQUEL GOMEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 693-0768
CITY:LOS OLIVOSSTATE: CAZIP CODE:
93441
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/30/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:02 AM
MET WITH:Maria GomezTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On December 30, 2024 at 11:02 AM, Licensing Program Analyst (LPA) Elizabeth George conducted an unannounced required 3- year Inspection at the above-mentioned family child care home (FCCH). LPA met with Licensee Maria Raquel Gomez and explained the purpose of the inspection. LPA, in the company of the Licensee, toured the interior and exterior of the FCCH. There were no children present at the time of the inspection.

Licensee stated that children have access to the dining room, kitchen, bathroom, one bedroom and outdoor play area. The home was orderly and clean with proper ventilation for all children in care. The bathroom used for care is clean and free of toxins. LPA observed a fireplace in the living room that is covered and made inaccessible to children. LPA observed that sharps, knives, medications and cleaning compounds/ detergents are stored in the kitchen on high shelves that are inaccessible to children in care. Toys, furniture and equipment in the facility are age appropriate.

LPA observed required licensing forms and documents posted by the entrance of the facility. LPA observed a smoke detector and carbon monoxide detector located in the bedroom. Both smoke detector and carbon monoxide detector's were tested and found to be operational at 11:40 AM. LPA observed a regulation fire extinguisher that was purchased on 9/27/24. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA reviewed the FCCH’s fire/disaster drill log. The most recent fire drill was conducted on 11/14/24.

LPA observed the backyard to be completely surrounded by brick wall. The FCCH was observed to have plenty of shade for the children in care. Toys and play equipment observed in backyard are age appropriate and in good conditions. LPA observed no bodies of water on site. Licensee informed LPA no firearms or ammunition are in the home. 809- C Continued on Page 2
Ana TolentinoTELEPHONE: (805) 562-0347
Elizabeth GeorgeTELEPHONE: 805-562-0400
DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 426210992
VISIT DATE: 12/30/2024
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A sample of children’s records was reviewed. All records reviewed are current. Current roster of children was reviewed by the LPA during inspection. LPA reviewed the Licensee’s Pediatric CPR/First Aid certifications which were completed on 12/23/24 and Mandated Reporter Training Certificate completed on 1/27/23. Licensee employs no additional personnel as she operates as a small FCCH.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.
To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
809-C Continued on Page3
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Elizabeth GeorgeTELEPHONE: 805-562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 426210992
VISIT DATE: 12/30/2024
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During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Appeals rights were provided.

Exit interview conducted and report was reviewed with the licensee, Maria Raquel Gomez.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Elizabeth GeorgeTELEPHONE: 805-562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
LIC809 (FAS) - (06/04)
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