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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421268
Report Date: 02/14/2024
Date Signed: 02/14/2024 01:50:11 PM

Document Has Been Signed on 02/14/2024 01:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:GOMEZ, ENAFACILITY NUMBER:
013421268
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
02/14/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:19 PM
MET WITH:Ena Gomez (Licensee) & Sulma Zevallos (Licensees assistant/ daughter)TIME COMPLETED:
02:00 PM
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On 2/14/24 at 1:19pm, Licensing Program Analyst Briana Plumboy met with licensee Ena Gomez for an UNANNOUNCED POC INSPECTION. At 1:28pm, assistant Sulma Zevallos arrived and granted LPA Plumboy access to the facility. Present for this visit was 2 infants and 4 preschool age children. The licensee is in ratio during today's inspection. The facility was toured and a physical census was taken. LPA Plumboy cleared licensee's deficiencies cited on 2/7/24 for the facility being out of ratio and verified current families in care signed Lic. 9224. Sulma Zevallos translated the inspection and report to licensee Ena Gomez from English to Spanish.

There are no deficiencies cited today. Copy of Cleared POC letter was provided. An exit interview was conducted. This report must be available for review for 3 years. A notice of site visit was posted. Appeal Rights Provided and discussed. Notice of site visit must remain posted for 30 days.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2024
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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