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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626280
Report Date: 09/01/2021
Date Signed: 09/01/2021 12:36:47 PM

Document Has Been Signed on 09/01/2021 12:36 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GOMEZ, CYNTHIA FAMILY CHILD CAREFACILITY NUMBER:
376626280
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
09/01/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cynthia GomezTIME COMPLETED:
12:33 PM
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On 09/01/2021 at 11:00 AM Licensing Program Analyst (LPA) Dana Stevens conducted a Case Management Inspection for the purpose of licensee initiated changes to the daycare area. LPA met with Licensee, Cynthia Gomez. One daycare child and licensee's mother/assistant were also present. Licensee accompanied LPA on a tour of the inside and outside of the 2 bedroom, one bath facility. Licensee will be using the following areas for daycare: Living room, kitchen, and bathroom. Off limits areas are: all bedrooms, laundry room, garage and backyard. These areas are made inaccessible with doorknob covers and door locks.There is a small partially fenced front yard that will be used for outdoor activities and Licensee understands that total supervision is required during outdoor play.
There is no fireplace on the premises. There are no bodies of water observed during time of visit. The fire extinguisher is rated 3A 40B:C and is located in the kitchen, smoke and carbon monoxide detectors meet requirements and are operational. All poisons, detergents, cleaning compounds, and medicines are inaccessible to children in care and are located in off limit areas with cupboard latches and door locks and secured out of reach of children.  Children’s toys and play equipment are available. The applicant has a working telephone/cell phone.  Applicant indicated there are no firearms or other weapons in the home. Applicant states they are financially secure to operate a family child care home for children and will comply with all regulations and laws governing family child care homes. The hours of operation are Monday through Friday,5:00 AM. to 8:00 PM.

Applicant is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248.

The new daycare areas are approved for use. LPA advised that prior to any construction or alterations to the home or grounds, the applicant shall notify the Department of the proposed change. An exit interview was conducted and a copy of this report and appeal rights were provided to licensee. Notice of site visit must be posted for 30 days.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2021
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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