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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216576
Report Date: 11/05/2024
Date Signed: 11/05/2024 11:44:06 AM

Document Has Been Signed on 11/05/2024 11:44 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GOMEZ FCCHFACILITY NUMBER:
566216576
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
11/05/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Magdalena Gomez TIME VISIT/
INSPECTION COMPLETED:
02:05 PM
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On November 5,2024 Licensing Program Analyst (LPA) Aaliyah Zendejas conducted an unannounced Case Management - licensee iniated inspection at the above-mentioned Family Child Care Home (FCCH) to change the capacity. LPA met with Co- Licensee, Heriberto Perez who was cleared and associated to the facility. LPA checked Co-Licensee's CPR and Mandated Reporter training and both were valid certificates. Co Licensee stated that the other Co-licensee, their wife, would be returning soon. LPA informed Co Licensee about the purpose of the inspection. At the time of the inspection 4 children were present. Co Licensee, Magdalena Gomez, arrived about 20 minutes after LPA had arrived to conduct visit.

LPA in the company of the Licensee toured the interior and exterior of the FCCH. LPA observed the home to be clean and orderly.

LPA observed a fire extinguisher that satisfies regulation (2A10BC) that has a service date of September 4, 2024. LPA reminded Licensee the responsibility to service or purchase a regulation fire extinguisher annually. LPA reviewed Licensee’s Mandated Reporter Training certificate which has an expiration date of 06/26/2026. LPA reviewed Licensee’s Pediatric CPR/First Aid which has an expiration date of 03/12/2026. LPA observed the home to have a carbon monoxide and fire detector properly working at the FCCH.

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 Oxnard Fire Department granted a fire clearance following an inspection completed at FCCH on 07/23/2024.

The home meets Title 22 of CCR requirements for a Large Family Child Care license. The effective date of license is today November 5, 2024.

Exit interview was conducted and Notice of Site visit was given.

SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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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