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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215912
Report Date: 03/13/2025
Date Signed: 03/14/2025 04:57:26 AM

Document Has Been Signed on 03/14/2025 04:57 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GOMEZ FAMILY CHILD CAREFACILITY NUMBER:
426215912
ADMINISTRATOR/
DIRECTOR:		LILIANA GOMEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 406-4091
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
03/13/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Liliana GomezTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On March 13, 2025, 12:20 PM, Licensing Program Analyst (LPA) Gigi conducted an unannounced Annual Random inspection at the above Family Childcare Home (FCCH) and met with Licensee, Liliana Gomez. LPA discussed the purpose of the inspection. Licensee provides care to children aged 0 to 12 years old.

During the inspection, LPA and Licensee toured the inside and outside of the home. LPA observed 4 children 1 of whom is an infant. The day care is operated at the sun room converted into daycare room, fenced backyard and the designated bathroom inside the main home. Children are accompanied by an adult when using it. The main home remains inaccessible to children. A sliding glass door divides the home and the day care. Parents dropped of the day care children using the gate in left side of the home and proceed straight to the daycare area.

The required licensing forms are posted in the prominent location. LPA observed age-appropriate toys and equipment inside the home. The outdoor space is free of any tripping hazards, age-appropriate play structure and toys were also observed. Knives and cleaning materials are stored inaccessible to the children in care. The bathroom for children’s use is free of toxins.

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 426215912
VISIT DATE: 03/13/2025
NARRATIVE
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LPA reviewed the facility and found that the Pediatric CPR and First Aid certificate expires on 10/21/2025 while Mandated Reporter Training Certificate expires on 4/17/2026. LPA reminded Licensee that it is their responsibility to renew the certificates every two years. The regulation fire extinguisher was purchased on 1/2/2025. The combination carbon monoxide and smoke detectors was tested and found functional. FCCH conducts fire and disaster drill every 3 months and last drill was conducted on 2/7/2025

Children’s files were reviewed and found complete. Licensee checks and documents napping infants every 15 minutes, the Individual Safe Sleep Plan is completed for infant aged 0-12 months. Nobodies of water was observed. Licensee confirmed there are no firearms and ammunition in the home.

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.

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

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.

Continued on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 426215912
VISIT DATE: 03/13/2025
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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, 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 is not providing Incidental Medical Services (IMS). 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/.

During the exit interview, the LICENSEE, Liliana 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, no deficiency was cited.

Notice of Site Visit was issued and must be posted for 30 days.

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

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
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