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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313838
Report Date: 11/13/2023
Date Signed: 11/13/2023 04:52:54 PM

Document Has Been Signed on 11/13/2023 04:52 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GONGORA VALENCIA, MARIA DEL MARFACILITY NUMBER:
304313838
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
11/13/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Maria Gongora, LicenseeTIME COMPLETED:
05:00 PM
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A case management inspection was conducted at the facility by Licensing Program Analyst (LPA) Tran and LPA Sun. LPAs observed licensee caring for 2 children including 1 infant and Licensee's child. Licensee was operating within the licensed capacity as specified on license. On 11/03/2023, Licensee submitted an application with updated facility sketch to add the living room into the day care area.

A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are 2 adults including the licensee residing in the facility. Facility Day care hours are 1am-12am, Monday through Friday, Saturday 12am-9am and Sunday 6pm-12am.

During today’s inspection, LPAs and licensee toured the inside and outside areas of the facility. Off limits areas are made inaccessible by means of baby gates. The living room was inspected for safety, comfort, cleanliness. It is adjacent to the kitchen and hallway that lead to the restroom and napping room. The living room meets requirements to be added into the facility sketch as a day care area

There is at least one working carbon monoxide, smoke detector, and fire extinguisher in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. There is no fireplace nor an open-faced heater in the living room. The home has age appropriate toys for the ages served. There were no poisons or other items observed which could pose a danger to children or if they were observed, they were locked or inaccessible.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 during today’s inspection. (Continue next page)
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GONGORA VALENCIA, MARIA DEL MAR
FACILITY NUMBER: 304313838
VISIT DATE: 11/13/2023
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(Page 2 of Report)

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. 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 Gongora.

(End of Report)
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
LIC809 (FAS) - (06/04)
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