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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016009
Report Date: 01/20/2022
Date Signed: 01/20/2022 01:28:12 PM

Document Has Been Signed on 01/20/2022 01:28 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GOMEZ FAMILY CHILD CAREFACILITY NUMBER:
198016009
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
01/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Licensee, Maria Gomez TIME COMPLETED:
01:45 PM
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-------------------------------------------------- Visit Conducted in Spanish---------------------------------------------------------

At 10:30 am Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced required 1 year inspection to the above facility. A risk assessment was conducted upon entry- appropriate PPE was used. LPA met with Maria Gomez, Licensee who guided analysts on a tour of the facility. Per Licensee, there is 1 child currently enrolled. A current children’s roster was available for review. There was 1 child present upon arrival. Also present during inspection was licensee’s husband and son.

The licensee states that 4 adults and currently live in the home. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms stored in the home.

This is a single-story home which consists of 3 bedrooms, 1 restroom, living room, dining room, kitchen, garage and backyard (fenced). The children have access to living room, dining room, 1 bedroom, kitchen (as a walkway to the backyard), the restroom and the backyard..

Per licensee, areas off limits to children and parents include, 2 bedrooms, garage and kitchen. The LPA toured all areas used by children during this visit.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a landline and a cellphone that stays at the facility during operation hours. There is ventilation and heating. The following was observed and reviewed during this inspection.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2022
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 198016009
VISIT DATE: 01/20/2022
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Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Poisons are locked in the off limits garage. The restroom that children use was observed to be safe and sanitary.

LPA Lopez did observed an accessible wall heater in the living room and hallway. Per Licensee, the wall heater was installed in 2015- and they were not informed that it had to be barricaded in previous visits. Per Licensee, she will put a barricade to make it inaccessible. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 3/1/2021, as indicated on receipt. Smoke and carbon monoxide detectors were tested and are operable. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 11/19/2021

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the living room.

The home is observed to be clean and orderly. There are toys available for children. Appropriate sleeping arrangements in form of cots are available.

Licensee states that they are not currently caring for infants. LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 198016009
VISIT DATE: 01/20/2022
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Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did observe aloe plants and cactus accessible to the children in care. Licensee, moved the items to an off limits section during inspection. Per Licensee, they will placed a fence dividing the fence in two will submit pictures.

LPA observed a fish tank in the dining room- there’s no other pets in the facility.

The licensee is observed to be operating within the license capacity limitations.

At 11:00 am children’s records were reviewed, including emergency information and were observed to be complete.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 3/2023. There are first aid supplies available.

LPA observed that the Licensee does have proof of immunization record and the Mandated Reporter AB 1207 compliant Child Care Training Certificate is expired.

LPA issued a copy of the LIC 857 Children’s Records Review to the licensee during this inspection.

IMS Yes
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 198016009
VISIT DATE: 01/20/2022
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Licensing staff consulted with licensing regarding COVID-19 health and safety guidelines on this date, Licensing staff did not observed COVID- 19 postings posted in the day care on this date- postings will be emailed. A RAST inspection is on file- During this inspection LPA discussed Social and Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

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

Exit interview conducted and report was reviewed with Licensee, Maria Gomez.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
LIC809 (FAS) - (06/04)
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