426217114-8-16-2024-17-CC-GGOZ-D87PNS-20240816112825

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426217114
Report Date: 08/16/2024
Date Signed: 08/16/2024 11:28:40 AM

Document Has Been Signed on 08/16/2024 11:28 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	GOMEZ FAMILY CHILD CARE		FACILITY NUMBER:	426217114
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	08/16/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Ma Gomez Torres		TIME VISIT/ INSPECTION COMPLETED:	11:41 AM

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This is a change of location, previous facility number 426216733.

On August 16, 2024 Licensing Program Analysts (LPAs) Giovani Gonzalez and Elizabeth George conducted an announced inspection at the above-mentioned residence. LPAs met with Ma Gomez Torres and informed them the purpose of the inspection. LPAs in the company of the Applicant toured the interior and exterior of the home in its entirety. At the time of the inspection there were no children present.

Applicant requested a change of location Family Child Care Home on 7/26/24. Applicant has the intention to have operating hours of 4AM - 6PM, Monday through Saturday. The residence is a single story house, consisting of 3 bedrooms, 2 bathrooms, living room, dining room, kitchen, attached garage and backyard. The home's living room, dining room, 2 bathrooms and backyard for child care purposes, while the remainder of the home is excluded from care.

LPAs observed the home to have plenty of space and ventilation for children in care. LPAs observed children's areas to be clean and orderly. LPAs observed the living room to have age appropriate toys and equipment. LPAs observed a fire place in the living room which is blocked off with a large wooden doll house that is secured to the floor. LPAs observed the dining room to be clean and free of hazards. LPAs observed the doorway to the garage to be secured with child proof locks. LPAs observed the kitchen have the ability to be made inaccessible with a child proof gate. LPAs informed applicant that when children are present the gate must be up in order for the kitchen to be made inaccessible. LPAS observed all lower kitchen cabinets and drawers to be secured with child proof locks. LPAs observed cleaning products and sharps to be stored in an elevated kitchen cabinet that is beyond the reach of children in care. LPAs observed all the hallway closets and bedroom doors have the ability to be secured with child proof locks. LPAs informed applicant that the doors must be secured when children are present for the areas to be inaccessible. LPAs observed both bathrooms to be used for child care purposes to be clean and free of toxins.

LPAs observed the backyard to be completely enclosed. LPAs observed sufficient space for children's

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SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GOMEZ FAMILY CHILD CARE	FACILITY NUMBER: 426217114
	VISIT DATE: 08/16/2024

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activities. LPAs observed an area that was fenced off and gate to the area is secured with a lock. LPAs informed applicant that in order for the area to remain inaccessible the gate must always be locked. LPAs observed age appropriate toys and equipment for child care purposes. LPAs observed the entry/exit way of the to be secured with a lock as well.

LPAs observed a fire extinguisher that satisfies regulation (3A40BC) that was purchased 8/12/2024. LPAs reminded applicant to purchase or service a regulation fire extinguisher annually. LPAs observed a smoke detector which was tested at 10:01AM and found to be operational. LPAs did not observe a carbon monoxide detector in the home and advised applicant that prior to licensure they must have one in the home. Applicant informed LPA that there are no firearms in the home. Applicant's Mandated Reporter training was completed on 7/21/2023, and CPR/First aid was completed on 5/18/2023. LPAs informed applicant that it is their responsibility to ensure that their training and certificates are current.

Applicant 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.

The applicant provided proof of control of property. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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) 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.

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SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GOMEZ FAMILY CHILD CARE	FACILITY NUMBER: 426217114
	VISIT DATE: 08/16/2024

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LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

On this date, 8/16/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Prior to licensure the following corrections must be made:
- Obtain a carbon monoxide detector.

Exit interview conducted and report was reviewed with the applicant Ma Gomez Torres. Notice of Site visit was given.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC809 (FAS) - (06/04)

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