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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628572
Report Date: 05/05/2020
Date Signed: 04/03/2024 11:57:10 AM

Document Has Been Signed on 04/03/2024 11:57 AM - 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, CINTHYA FAMILY CHILD CAREFACILITY NUMBER:
376628572
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
05/05/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cinthya Gomez - ApplicantTIME COMPLETED:
01:25 PM
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Licensing Program Analyst (LPA) Edgar Campana and Licensing Program Manager (LPM) Jason Garay conducted an announced prelicensing inspection with applicant, Cinthya Gomez, via FaceTime. Purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This two story, four bedroom, three bath house with a garage was toured and inspected.

Applicant will use the following areas for child care: living room 1, living room 2, daycare bathroom (bathroom 1), and patio. Off limits areas include: kitchen, dining room, garage, and entire upstairs (4 bedrooms, 2 bath). They are made inaccessible to day care children through the use of door locks, doorknob covers, and safety gates. Applicant will utilize the patio for outdoor activities, it is properly fenced. The upstairs is not used and will be barricaded at the bottom of the stairway and the applicant understands the gate must be in place when children under five years are present during day care hours. The fireplace is screened and the applicant stated will not used during daycare hours. There are no bodies of water at the property, however there is a community pool and water safety was discussed with applicant. The fire extinguisher is rated 2A 10B:C and is located in the dining room, smoke and carbon monoxide detectors meet requirements and are operational. All 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 cell phone. Applicant indicated there are no firearms or other weapons in the home.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2020
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, CINTHYA FAMILY CHILD CARE
FACILITY NUMBER: 376628572
VISIT DATE: 05/05/2020
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Applicant maintains documentation of proof of control of property for review by the Department. Applicant has completed the 8 hours of preventative health. Pediatric CPR and First Aid certifications expire on 12/2021. Required documents will be posted. Applicant and adult residents in the home have criminal record clearances. Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Any minor upon their 18th birthday must be fingerprinted. Immunization records per SB792 were reviewed and are in compliance. 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 are Monday through Friday, 6:30 a.m. to 05:00 p.m.

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

The New Provider Resource Packet was reviewed with the applicant including information on the following: Safe Sleep, Lead Exposure, SIDS, shaken baby, child abuse reporting, community resources, children’s records, facility records, required postings, immunizations, unusual incident report, facility roster, car seat law, visual for ratio/capacity, fire/disaster drill log. Applicant was also informed the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2020
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, CINTHYA FAMILY CHILD CARE
FACILITY NUMBER: 376628572
VISIT DATE: 05/05/2020
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LPA discussed the maximum capacity for a small family child care home: four infants only (infants mean any children under 24 months); or six children with no more than three infants; or, eight children with no more than two 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.

Southern California Child Care Advocate information was provided and applicant was encouraged to subscribe through the CCLD website in order to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

Proof of the following corrections are needed via email prior to the issuance of the license:
  • Sharp knives and cleaning agents in the kitchen will be made inaccessible
  • Hazardous items in living room 1 closet will be made inaccessible
  • Play structure in patio will have the fall zones protected as this structure is placed over concrete
  • Staircase leading to the second floor will be made inaccessible
  • Hazardous items in garage will be made inaccessible by doorknob cover on interior door
  • Updated sketch of patio with grill area, storage, gates
  • Updated sketch of Garage/bedroom will be
  • Battery for smoke detector in upstairs bedroom

A Regular Small Family Child Care Home license may be issued upon final file review. LPA Campana interpreted and explained inspection report to applicant in Spanish, applicant stated she understood. An exit interview was conducted and copy of the report will be provided to the applicant via email. Applicant understands that confirmation of receipt of the email must be provided within 24 hours of report being received.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2020
LIC809 (FAS) - (06/04)
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