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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628311
Report Date: 08/03/2023
Date Signed: 08/03/2023 02:56:17 PM

Document Has Been Signed on 08/03/2023 02:56 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, ERIKA & QUINONEZ, RAQUEL FAMILY CHILD CAREFACILITY NUMBER:
376628311
ADMINISTRATOR:ERIKA G. & RAQUEL Q.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 302-5311
CITY:CHULA VISTASTATE: CAZIP CODE:
91915
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Erika GomezTIME COMPLETED:
03:00 PM
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On August 03, 2023 at 01:30 PM, Licensing Program Analyst (LPA), Edgar Campana conducted an unannounced Annual Required Inspection and met with the Licensee, Erika Gomez.  LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee.  No children were present in the facility during this inspection. Licensee accompanied LPA on a tour of the facility. This two story, 3 bedroom, 2 1/2 bath home was inspected. The following areas are used for childcare: living room, dining room, patio and downstairs bathroom. The second floor, kitchen and garage are the off limit areas. Child safety gates barricade the stairs. A child safety knob is on the garage door.

The fire extinguisher (rated 2A-10 BC) smoke detector, and carbon monoxide detectors met requirements.  All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. Fireplace was properly screened. Licensee’s First Aid and CPR certifications expire on 10/2023.  Licensee has required immunizations.  Licensee's Mandated Reporter Training certificate expires on 10/06/2024. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted on June 14, 2023.

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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2023
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GOMEZ, ERIKA & QUINONEZ, RAQUEL FAMILY CHILD CARE
FACILITY NUMBER: 376628311
VISIT DATE: 08/03/2023
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

No deficiencies cited.

Exit interview conducted and report was reviewed with the licensee Erika Gomez.

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

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

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
LIC809 (FAS) - (06/04)
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