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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016009
Report Date: 02/24/2025
Date Signed: 02/24/2025 10:53:41 AM

Document Has Been Signed on 02/24/2025 10:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GOMEZ FAMILY CHILD CAREFACILITY NUMBER:
198016009
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 2DATE:
02/24/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Maria GomezTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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This inspection was conducted in Spanish.

Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced Annual/Random inspection at the above facility on 02/24/25 at 09:25 a.m. LPA met with, Maria Gomez licensee who guided LPA on a tour of the facility. There were 02 children present during this inspection. Also present during the inspection was the licensee’s husband. Per licensee, 04 children are enrolled. Operation hours are Monday – Friday 06:00 a.m. – 06:00 p.m.

This is a one-story home which consists of 3 bedrooms, 1 bathroom, living room, dining room, kitchen, garage, front yard, and backyard (fenced). Areas accessible to children include the living room, dining room, 1 bedroom, 1 bathroom, and back yard (fenced) for play. Per licensee, areas off limits to children and parents include 2 bedrooms, kitchen, front yard, and garage. Per licensee, there are (2) fishes on the premises. Per licensee, family members residing in the home are 4 adults and 0 minors. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home and are identified on the attached LIC811.

LPA toured all areas identified on the facility sketch used by children during this visit and were inspected for safety, comfort, and cleanliness. Tour began in living room where LPA observed age-appropriate toys, equipment, and materials for children. LPA also observed (3) cots and a barricaded wall heater. Adjacent to the living room is the dining room where LPA observed (1) fish tank with 2 fishes and a dining table. There is a well mounted gate between the dining room and the kitchen. According to the licensee, the kitchen is off-limits. LPA toured the children’s bathroom located in the hallway between the 3 bedrooms. The children’s bathroom is in safe and in sanitary conditions. The children have access to 1 bedroom located across from the bathroom where LPA observed a changing table, age-appropriate toys, and materials for children. There’s also a first aid kit readily available.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2025
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 198016009
VISIT DATE: 02/24/2025
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LPA observed the following required posted documentation in the living room of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed facility records LIC 610- Emergency Disaster Plan and Disaster drill log. 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 conducted on 01/05/25. Children’s roster was available during this inspection.

Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary. **Rooms that are off-limits need to be made inaccessible during operating hours**

Per licensee, food is provided to children. Licensee was advised that if food is brought from the children’s homes, all containers must be labeled with the child’s name and properly stored or refrigerated. There is a telephone service via a landline and cellphone. There is ventilation and heating.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. Per licensee, there are no firearms or weapons stored in the home.

At 09:41 a.m. smoke and carbon monoxide detectors were observed to be operable. The valve on the required 3A40BC fire extinguisher indicates fully charged and was purchased on 06/10/24, per the attached tag. According to the licensee, the fire extinguisher was provided by the Mexican American Opportunity Foundation (MAOF) and only provided her with the attached tag. LPA advised licensee that proof of purchase or service must be available during the inspection. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.

The isolation area for sick children waiting to be picked up is in the dining room with supervision.

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

Children are currently using the back yard for outdoor play. LPA observed natural shade and age-appropriate play equipment. LPA did not observe any objects that could be hazardous to children in care. LPA advised licensee to check with the American Standard Testing Materials for Playground Guidelines and/or to use the manufactures recommendations for the playground equipment in efforts to be more in line with safety guidelines. Licensee understands that children should be supervised at all times.

LPA did not observe any pools, spas, hot tubs, fishponds, or similar bodies of water during the inspection.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 198016009
VISIT DATE: 02/24/2025
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Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, and LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). LPA observed all children’s files to be complete.

Licensee’s records were reviewed for approved Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. Licensee’s Mandated Reporter Training expires on 02/06/26. Licensee’s Pediatric CPR/FA expires on 02/08/27.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018, any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

Licensee does not care for infants. 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-andresources/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. No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers, and any other item that falls into that category.

The licensee is operating within proper capacity and ratios. LPA observed the licensee to be present at the home and providing adequate care and supervision.

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/.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 198016009
VISIT DATE: 02/24/2025
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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.

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.

Licensee Maria Gomez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

At this time, the facility is in compliance with California Title 22 Regulations. Therefore, there are no deficiencies being issued today.

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

Exit interview conducted and report was reviewed with the licensee Maria Gomez.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
LIC809 (FAS) - (06/04)
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