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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215578
Report Date: 01/05/2026
Date Signed: 01/05/2026 03:33:57 PM

Document Has Been Signed on 01/05/2026 03:33 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
SANTA BARBARA CC RO, 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: DATE:
01/05/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Kashia GomezTIME VISIT/
INSPECTION COMPLETED:
03:48 PM
NARRATIVE
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On January 5, 2026, at 12:55 PM, Licensing Program Analyst (LPA) Elizabeth George conducted an unannounced annual random inspection at the above-mentioned family child care home (FCCH). LPA met with Licensee Kashia Gomez and explained the purpose of the inspection. LPA, in the company of the Licensee, toured the interior and exterior of the FCCH. At the time of the inspection 6 children were present along with assistant, licensee’s spouse (cleared and associated).

Licensee stated that children have access to the back day care room, bathroom, and backyard. While the 2nd floor and garage are completely inaccessible to children in care. Stairs are made inaccessible to children in care by a gate at the base of the stairwell. Upon arrival LPA observed an infant swaddled and asleep on a couch in the living room. Licensee was advised to move infant, infant was moved upon waking. The home was orderly and clean with proper ventilation for all children in care. The bathroom used for care is clean and free of toxins. LPA observed a fireplace in the living room that is covered and made inaccessible to children. LPA observed that sharps, knives, cleaning compounds and medications are stored in the kitchen which is off limits to children in care. Toys, furniture and equipment in the facility are age appropriate.

LPA observed required licensing forms and documents posted within the daycare room of the facility. LPA observed a smoke detector and a carbon monoxide detector which were tested and found operable at 2:43 PM. LPA observed a regulation fire extinguisher that was serviced 1/29/25. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The most recent fire drill was conducted and documented on 11/25/25.

continued on 809-C
NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Elizabeth George
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 426215578
VISIT DATE: 01/05/2026
NARRATIVE
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LPA observed the backyard to be completely fenced. The FCCH was observed to have plenty of shade for the children in care. Toys and play equipment observed in backyard are age appropriate and in good conditions. LPA observed no bodies of water on site. Licensee informed LPA no firearms or ammunition are in the home.

A sample of children’s records was reviewed. LPA provided licensee with the LIC126 Entrance Checklist and recommend a review of the children’s files to ensure completeness of all forms. Facilities current roster of children was reviewed by the LPA. In one out of one files LIC9227 was not provided for infant under 12 months of age. LPA observed completed and up to date infant sleep logs. Licensee was reminded to initial and date every 15 minutes on the log. Licensee’s Pediatric CPR and First Aid certifications are current and expire July 2026. Mandated Reporter Training Certification expires September 2026. Assistants Mandated Reporter certification is current. Staff records were reviewed and found to be complete.

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.

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-and-resources/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 22-02-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)/ (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/.
Continued on 809-C
NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Elizabeth George
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 426215578
VISIT DATE: 01/05/2026
NARRATIVE
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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.

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

During today's inspection one Type A and two Type B citations were issued under California Code of Regulations Title 22 can be found on the attached 809-D's. One technical violation was issued.

LPA informed Licensee Kashia Gomez that this report dated 1/5/26 documents one (1) Type A citation which shall be posted for 30 consecutive days as there is/ are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA informed the Licensee to provide a copy of this licensing report dated 1/5/26 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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



Exit interview conducted, appeals rights were provided and report was reviewed with the licensee, Kashia Gomez.
NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Elizabeth George
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/05/2026 03:33 PM - It Cannot Be Edited


Created By: Elizabeth George On 01/05/2026 at 02:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 426215578

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(f)
Infant Safe Sleep
An infant shall not be swaddled while in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in upon arrival licensee had infant under 12 months swaddled and asleep on the couch which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/06/2026
Plan of Correction
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Licensee removed the infant from the couch during the inspection. Licensee to submit a written statement on how facility will maintain infant safe sleep regulations in the future which can be emailed to elizabeth.george@dss.ca.gov no later than January 6, 2026.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Tolentino
NAME OF LICENSING PROGRAM MANAGER:
Elizabeth George
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/05/2026 03:33 PM - It Cannot Be Edited


Created By: Elizabeth George On 01/05/2026 at 02:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 426215578

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in infant under 12 months was asleep on the couch upon LPAs arrival which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/09/2026
Plan of Correction
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Licensee removed the infant from the couch during the inspection. Licensee to submit a written statement on how facility will maintain infant safe sleep regulations in the future which can be emailed to elizabeth.george@dss.ca.gov no later than January 6, 2026.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one out of one infant files did not have the LIC 9227 Individual Infant Sleeping Plan completed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/09/2026
Plan of Correction
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Licensee to obtain a LIC9227 Individual Infant Sleeping Plan for all children under 12 months of age. Submit proof of paperwork obtained to elizabeth.george@dss.ca.gov no later than January 9, 2026.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Tolentino
NAME OF LICENSING PROGRAM MANAGER:
Elizabeth George
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2026


LIC809 (FAS) - (06/04)
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