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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626280
Report Date: 11/07/2024
Date Signed: 11/07/2024 02:05:06 PM

Document Has Been Signed on 11/07/2024 02:05 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GOMEZ, CYNTHIA FAMILY CHILD CAREFACILITY NUMBER:
376626280
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
11/07/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Cynthia GomezTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 11/07/2024 Licensing Program Analyst (LPA), Dana Stevens conducted an unannounced Inspection for the purpose of capacity increase. LPA met with Licensee, Cynthia Gomez, disclosed the purpose of the inspection and was granted entry into the facility. There were 4 daycare children present at the time of the inspection. Licensee accompanied LPA throughout the inspection of this 2 bedroom, 2 bathroom home. Applicant will use the following areas for child care: Living room, kitchen, daycare room, and both bathrooms. Off limits areas include: both bedrooms and laundry room. These areas are made inaccessible to day care children with doorknob covers. Applicant will now utilize the back yard for outdoor activities, it is properly fenced.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements.  The licensee has toys, play equipment and materials available. Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.  Licensee and assistant completed Mandated Reporter training in 09/2024. Licensee's First Aid and CPR certification is current and expires 08/2025. Assistant's First Aid and CPR certification is current and expires 11/2025. Licensee and assistant have required immunization. Facility roster was reviewed and found complete. A total of 8 children are currently enrolled. A sample of children's files were reviewed and found complete.



There is one crib or play yard for each infant who is unable to climb out of the crib or play yard.  Cribs or play yards are free from all loose articles and objects. The provider physically checks on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age.  The provider places infants up to 12 months of age on their backs for sleeping.
SUPERVISORS NAME: Cynthia Biszant
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GOMEZ, CYNTHIA FAMILY CHILD CARE
FACILITY NUMBER: 376626280
VISIT DATE: 11/07/2024
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LPA advised that prior to making alterations or additions to the home or grounds, the applicant shall notify the Department of the proposed change. 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 M-F 6:00 AM - 6:30 PM.

Applicant does not plan on providing Incidental Medical Services (IMS) to clients at this time.  IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417.  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:  http://www.ada.gov/childqanda.htm
 
LPA discussed the maximum capacity for a Large family childcare home: 12 children with no more than 4 infants; 14 children with no more than 3 infants, one child in kindergarten or elementary school and one child at least age six, including children under age 10 who live in the home.

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.
 
A Large Family Child Care Home license is granted effective this date. An exit interview was conducted and a copy of the report was provided to the applicant
SUPERVISORS NAME: Cynthia Biszant
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC809 (FAS) - (06/04)
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