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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217114
Report Date: 01/22/2025
Date Signed: 01/22/2025 11:40:42 AM

Document Has Been Signed on 01/22/2025 11:40 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 CAREFACILITY NUMBER:
426217114
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
01/22/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:57 AM
MET WITH:Ma Gomez Torres TIME VISIT/
INSPECTION COMPLETED:
11:55 AM
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On January 22, 2025, Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Case Management - Change of Capacity inspection at the above-mentioned Family Child Care Home (FCCH). LPA met with licensee Ma Gomez Torres and informed them the purpose of the inspection. LPA notes that this inspection will also serve to approve use of a bedroom for child care purposes. At the time of the inspection there were 2 children present and 1 assistant.

LPA in the company of the Licensee toured the FCCH. LPA observed the FCCH’s interior and exterior to be free of hazardous materials that could pose a danger to children in care. LPA observed the bedroom to be used for child care purposes to be free of hazards. LPA notes the bedroom is approved for child care purposes.

LPA observed a fire extinguisher that satisfies regulation (3A40BC) that was purchased 8/12/2024. LPA reminded Licensee the responsibility to service or purchase a regulation fire extinguisher annually. LPA reviewed Licensee’s Mandated Reporter Training certificate which was completed 5/16/2023 . LPA reviewed Licensee’s Pediatric CPR/First Aid which was completed 5/18/2023. LPA observed a combination smoke and carbon monoxide detectors to be operational at 11:28AM.

The Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). The Santa Maria Fire Department granted a fire clearance following an inspection completed at FCCH on 1/20/2025.

The home meets Title 22 of CCR requirements for a Large Family Child Care license. The effective date of license is today 1/22/2025.

Exit interview was conducted with licensee Ma Gomez Torres and Notice of Site visit was given.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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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