<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215912
Report Date: 04/30/2020
Date Signed: 05/01/2020 09:49:10 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:
426215912
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
04/30/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Liliana GomezTIME COMPLETED:
03:00 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 4/30/20, at 2:05 PM , Licensing Program Analyst (LPA) Elvin Baddley conducted a Prelicensing Inspection of the abovementioned address. Due to COVID 19 and Department of Public Health guidelines of social distancing, this inspection was conducted with Applicant Liliana Gomez via FaceTime. It should be noted the present inspection trailed a Prelicensing Inspection conducted on 3/2/20 (see LIC 809), whereby the Applicant's Family Chid Care Facility (FCCH) license was pending the following corrections:

1. Operable Smoke and carbon monoxide detectors
2. Electric socket plate cover placed in sun room
3. Completion of backyard fencing (dividing exclude area from area for child care)

During this tele-inspection the applicant took LPA on a tour of the interior and exterior of the home. During this tour, LPA observed the home's backyard contained a wooden fence, with welded wiring, which served as a partition between the areas of exclusion and child care. The fences' entry/exit points were observed to be secure. At 2:10 PM, the Applicant tested the home's combination smoke/carbon monoxide detector. The combination smoke/carbon monoxide detector was determined to be operable after the LPA heard an audible chirping sound. The home's sun room contained electric socket plate covers on all reciprocals.

The aforementioned served as corrections need for FCCH license.

Applicant was made aware the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license will be noted as 4/30/20.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2020
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 1