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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408248
Report Date: 01/07/2025
Date Signed: 01/07/2025 10:39:28 AM

Document Has Been Signed on 01/07/2025 10:39 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GOMEZ, LAURAFACILITY NUMBER:
434408248
ADMINISTRATOR/
DIRECTOR:		LAURA GOMEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 723-0801
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/07/2025
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:48 AM
MET WITH:Laura GomezTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Teodoro Trujillo and Licensing Program Manager (LPM) Susy Cervantes Conducted a scheduled Informal Office meeting at the San Jose Regional Office with Licensee Laura Gomez to discuss issues and citations issued on 10/14/2024, 03/30/2023, 03/13/2019 and 04/23/2014.

On 10/14/2024, LPA Deanna Villagrana, observed mouth wash, shampoo, and toothpaste in the on limits bathroom accessible to children. LPA Villagrana observed infant sleeping with a blanket and bottle in the play yard and LPA observed licensee went outside with other children to serve them lunch and was unable hear sleeping infant.

On 03/30/2023, LPA Teodoro Trujillo observed personal hygiene products (acne face cleansers) were accessible in the on- limit bedroom closet and bottom left computer desk drawers, mouth wash and tube of sunscreen and adult toothpaste accessible in on limit bathroom sink. LPA Trujillo observed, three-five (5) gallon and one- four (4) gallon buckets were filled with water to the rim, on right side - off limit area with no gate, accessible to children in care.

On 03/13/2019, LPA Janet Tse observed there were seven children with no school age children present with Licensee alone. At arrival, LPA Tse observed three children sleeping in the off-limits master bedroom. Licensee did not notify Licensing of the change of the off-limits area into an area where care and supervision are provided to children in care.
LPA Tse observed items that are dangerous to the health and safety of children accessible to children in the home.
On 04/23/2014, LPA Tse cited licensee for picking up children late from school, children sat in front of school or in office and outside when office is closed until provider arrived and children lost in library looking for provider, who was in the library. The licensee shall be present in the home and shall ensure that children in care are supervised at all times.


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SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GOMEZ, LAURA
FACILITY NUMBER: 434408248
VISIT DATE: 01/07/2025
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LPM Susy Cervantes, explained that if there are continued serious deficiencies cited against the facility including but not limited to citations for staying in ratio and capacity, hazardous items accessible to children, complying with safe sleep requirements, and physical plant requirements, the licensee may be referred to legal for possible administrative action, which could include revocation of the facility license. The facility will be monitored more frequently to ensure that the facility is maintaining compliance with Title 22 regulations. Licensee Laura Gomez was provided a copy of the regulations regarding Staffing Ratio and Capacity, Safe Sleep regulations, maintaining safety equipment including but not limited to fire extinguishers, and operation of a Family Child Care Home for bodies of water.

Licensee states she will be seeking assistance with the local Resource and Referral Agency as well as review the licensing website for additional information: www.ccld.ca.gov. LPM Cervantes discussed Technical Support Program (TSP), the Regional Office will be sending a referral to the program, licensee Laura Gomes was provided with the TSP flyer and licensee was informed TSP is voluntary and will be getting a phone call from TSP.

LPM Susy Cervantes discussed the requirement of AB 633 in English and Spanish with Licensee Laura Gomez and provided her with the AB 633 fact sheet in English and Spanish and a copy of Acknowledgment of Receipt of Licensing Reports (LIC 9224) and understands the requirements.

Copies of this report dated 01/07/2025 must be provided to Parents/Guardians of children currently in care at this Facility and to the Parents/Guardians of newly enrolled children at the Facility for the next 12 months.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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