426217236-12-11-2024-17-CC-EBAY-DBUREE-20241211115725

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426217236
Report Date: 12/11/2024
Date Signed: 12/11/2024 11:57:32 AM

Document Has Been Signed on 12/11/2024 11:57 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-GUEVARA FAMILY CHILD CARE		FACILITY NUMBER:	426217236
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	12/11/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:20 AM
MET WITH:	Esmeralda Gomez-Guevara		TIME VISIT/ INSPECTION COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 12/11/24, at 9:20 AM, Licensing Program Analysts (LPAs) Elvin Baddley and Shane Loftus conducted an announced Prelicense Inspection of the abovementioned home and met with Applicant Esmeralda Gomez-Guevara. LPAs informed Applicant of the nature and purpose of the inspection. Applicant informed LPAs of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 12:00 AM- 11:59 PM, Monday- Sunday. Applicant also intends to care for children 0 years of age to 12 years of age. Applicant informed LPAs of Applicant's plan to began child care services at the beginning of the new year (January 2025) when licensed. Applicant was informed changes in licensing hours or the ages of children supervised and cared for in the home can be altered upon notifying CCLD of the modifications or changes. LPAs notes one child (biological) is on site at the time of the inspection. LPAs, in the company of Applicant, toured the interior and exterior of the home in its entirety. The home is a three bedroom, two bathroom, single story dwelling with an attached Accessory Dwelling Unit (ADU). It should be noted Applicant provided LPAs with the approved building permit for the ADU. The home's ADU, which containing living room space and a bathroom, will be used for child care services, while the main residence/remainder of the home is excluded from child care. The home's ADU has spacing and ventilation for children in care. The home's ADU has no fireplaces, however the home has central heating throughout. The bathroom to be used by children in care is observed to be clean and free of toxins. Cleaning compounds are located in the main residence (under the sink in the kitchen and bathroom) which are excluded from care. Likewise, sharps are located on the kitchen counter and medication are observed in an elevated kitchen cabinet, which is in an excluded area. LPAs observed the home to be clean and orderly. LPAs observed a fire extinguisher (2A10BC) in the home which was purchased on 10/11/24. LPAs reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has combination smoke/carbon monoxide detectors throughout. A combination smoke/carbon monoxide detector was tested (CONT. LIC 809-C, Page 2)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GOMEZ-GUEVARA FAMILY CHILD CARE	FACILITY NUMBER: 426217236
	VISIT DATE: 12/11/2024

NARRATIVE

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in the ADU at 9:34 AM and found to be operable. The residence has operating telephone services.

The home's backyard is enclosed by a combination of wooden and cider block fencing. The footing in the area is varied. The backyard's entry/exit gate is secured. The back yard is partition by a child safety gate to separate a side yard for personal use from the area used for child care. LPAs observed one shed in the backyard area which contain household supplies and yard tools. A storage box is also observed in the backyard which contains children's toys. Applicant informed LPAs Applicant will occasionally utilize neighboring parks for outdoor activities. LPAs informed Applicant of the importance of maintaining direct supervision of children in care when traveling outside of the home. LPAs note no bodies of water were observed on site.

LPAs' record review revealed Applicant's Mandated Reporter training was completed on 9/6/24 (expiration 9/6/26), and Pediatric CPR/First Aid (EMSA approved) training was completed on 10/27/24 (expiration 10/27/26). Applicant completed Preventative Health on 9/27/24, and CCLD's Orientation on 8/13/24. LPAs reminded Applicant of obligation to maintain current training and certifications. The Applicant provided proof of control of property. Applicant informed LPAs no firearms or ammunition are on site.

LPAs 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.

The Applicant will no be providing Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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 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. LPAs also informed Applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety (CONT. LIC 809-C, Page 3)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GOMEZ-GUEVARA FAMILY CHILD CARE	FACILITY NUMBER: 426217236
	VISIT DATE: 12/11/2024

NARRATIVE

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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.

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.

On this date, 12/11/24, the California Attorney General - Megan’s Law website was 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 address. 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 is 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 platform.

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.

Exit interview conducted and report was reviewed with the Applicant Esmeralda Gomez-Guevara. The home meets Title 22 Division 12 requirements of a FCCH Small License. Effective date of license will be noted as the present, 12/11/24.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

LIC809 (FAS) - (06/04)

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