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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215578
Report Date: 10/24/2024
Date Signed: 10/24/2024 11:01:02 AM

Document Has Been Signed on 10/24/2024 11:01 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GOMEZ FAMILY CHILD CAREFACILITY NUMBER:
426215578
ADMINISTRATOR/
DIRECTOR:		KASHIA GOMEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 714-0699
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
10/24/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Kashia GomezTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 10/24/24, at 8:50 AM, Licensing Program Analysts (LPAs) Elvin Baddley and Elizabeth George conducted an unannounced Three Year Required Inspection of the abovementioned Family Child Care Home (FCCH). LPAs met with Kashia Gomez, Licensee of the FCCH, and explained the purpose of the inspection. LPAs, in the company of the Licensee, toured the exterior and interior of the FCCH. The FCCH is a two story dwelling with three bedrooms and two and a half bathrooms. The FCCH's living room, converted family room, kitchen, dining room, first floor bathroom and backyard are used for child care, while the remainder of the home is excluded from child care. LPAs observed a child safety gate at the base of the stairwell, barricading the first story of the home from the upper story. At the time of the inspection, LPAs observed two children present along with an Assistant (Spouse, cleared and associated).

LPAs observed required forms posted on the wall of the converted family room. Cleaning compounds, sharps and medications in the FCCH are located in elevated cabinets in the kitchen area, which are inaccessible to children in care. LPAs observed a fireplace in the FCCH's living room which was screened by glass. LPAs observed a combination smoke and carbon monoxide detector in the FCCH. The aforementioned was tested at 9:05 AM and found to be operable. The FCCH has a regulation fire extinguisher (2A10BC) which was purchased on 1/26/24. LPAs reminded the Licensee to either service or purchase a regulation fire extinguisher annually. Toys, furniture and play equipment observed in the FCCH are age appropriate. The home maintains working telephone services.

The backyard of the FCCH is enclosed by wooden fencing. The backyard's entry/exit gate is secured. The footing in the backyard is varied. The backyard is partitioned to separated an area used by children from an area used for personal use. Toys and play equipment observed in backyard area are age appropriate. LPAs observed a shed in the backyard of the FCCH. The shed is secure and contains household items. LPAs observed a jacuzzi in the area of the backyard used for personal use. LPAs observed the jacuzzi to be locked and secured, LPAs note the access gate to the jacuzzi is locked. The FCCH has a small dog on site. LPAs reviewed vaccination records for the dog and notes the vaccinations are current. (CONT. LIC 809-C, Page 2).
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 426215578
VISIT DATE: 10/24/2024
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LPAs reviewed children, staff and facility records. Children's records are current, Children's records sampled possessed emergency contact information, sleep logs and immunization records, among other required licensing forms. Licensee's records are current and complete with pedantic CPR /First Aid certifications (EMSA approved) expiring on 7/20/26, and Mandated Reporter training certification expires on 9/22/26. The Licensee informed LPAs no firearm or ammunition are stored on site. LPAs reviewed the facility's roster which noted the names of children in care. A review the facility disaster drills note the last disaster drill conduced on site was on 8/27/24.

Incidental Medical Services (IMS) are not provided by Licensee. IMS policy was discussed. For IMS information see PIN 22-02 CCP. 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) or (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.

LPAs 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-and-resources/safe-sleep as an additional resource. LPAs 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.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS on 10/24/24.
(CONT. 809-C, Page 3)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 426215578
VISIT DATE: 10/24/2024
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A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Kashia Gomez.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC809 (FAS) - (06/04)
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