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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300072
Report Date: 08/30/2023
Date Signed: 08/30/2023 02:12:59 PM

Document Has Been Signed on 08/30/2023 02:12 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:GOMES FAMILY CHILD CAREFACILITY NUMBER:
336300072
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
08/30/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sherryl GomesTIME COMPLETED:
02:20 PM
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On August 30, 2023 at 1:00 pm, Licensing Program Analyst (LPA) Cindy Hamilton arrived to the facility to conduct and case management visit to increase the license capacity from a small family child care home to a large family child care home. A fire clearance was granted for an increase of capacity on 7/19/2023 for the downstairs only. Present in facility was licensee Sherryl Gomes, Assistant Patricia Spaulding and 6 children (3 were infants). LPA met with licensee and toured the facility and the following was observed and/or discussed:

· Normal days and hours of operation are: Monday through Friday 7:00 am - 5:30 pm.

· Off-limit areas include: The entire second story and garage.

· All hazardous items are stored inaccessible to children locked under kitchen sink

· Weapons are NOT present. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· Stairs are barricaded

· Clean, safe, and age-appropriate toys are provided

· Facility Sketch, Emergency Disaster Plan and Notification of Parent’s Rights poster are posted

· No bodies of water are present at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2023
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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: GOMES FAMILY CHILD CARE
FACILITY NUMBER: 336300072
VISIT DATE: 08/30/2023
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· Licensee's Pediatric CPR and First Aid Card expires on 8/2025

· Resident and/or staff records were reviewed and all adults who require caregiver background checks have received all required clearances and/or exemptions.

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.

The Large Family Child Care Home License will be submitted for approval with a maximum capacity of 12, or 14 with parent notification.



An exit interview was conducted, and this report, appeal rights and notice of site visit was discussed and provided to the licensee Sherryl Gomes. Licensee was reminded the notice of site visit must remain posted for 30 consecutive days.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC809 (FAS) - (06/04)
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