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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841661
Report Date: 09/12/2024
Date Signed: 09/12/2024 06:26:15 PM

Document Has Been Signed on 09/12/2024 06:26 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GOMEZ FAMILY CHILD CAREFACILITY NUMBER:
334841661
ADMINISTRATOR/
DIRECTOR:		GOMEZ, MARICELDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 340-3639
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/12/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
06:14 PM
MET WITH:Maricelda Gomez, Licensee TIME VISIT/
INSPECTION COMPLETED:
06:35 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 date and time listed, Licensing Program Analyst (LPA) Claudia Caywood arrived at the facility to conduct a case management inspection regarding amending an inspection report 809-D page.

During visit, LPA amened a 809-D page to read cleaning compounds and not poisons. Licensee wanted the word poison replaced due to concerns perspective parents overlooking her facility during their visit to possibly choose her facility as a daycare option for their children. Initially, the word poison was used but should have been cleaning compound instead because the Clorox wipes are not poisonous.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

During the exit interview, the LICENSEE Maricelda Gomez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the Licensee Maricelda Gomez.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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 1