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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421751
Report Date: 09/13/2023
Date Signed: 09/13/2023 01:28:11 PM

Document Has Been Signed on 09/13/2023 01:28 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:GOMEZ, BRENDA & MARTINEZ, BELINDAFACILITY NUMBER:
013421751
ADMINISTRATOR:GOMEZ, BRENDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 266-3621
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
09/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:36 PM
MET WITH:Brenda Gomez & Belinda MartinezTIME COMPLETED:
03:19 PM
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Licensing Program Analyst Sidney Cortez, met with licensee Brenda Gomez & Belinda Martinez for an Unannounced Annual Random Inspection. Present for this visit was the licensee(s) Brenda Gomez & Belinda Martinez, there (2) fingerprint cleared assistants Yolanda Noguera, Berman Gomez and (2) infants, and (5) pre school age children (total of 7 children)
The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 6:00AM until 7PM, MONDAY-FRIDAY.
The home is single story, which consists of 4 bedrooms, one bathroom, kitchen, living room dining room and patio.


The ON LIMIT areas are the living room, dining room, kitchen, bathroom in hallway, all 4 bedrooms,and patio.
The OFF-LIMIT areas are unchanged since the most recent site inspection and were inaccessible by closed doors or child safety gating and visual supervision at all times. Isolation area will be the living room area next to the entrance.
There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children. Per licensee, there are no firearms in the home.

The home has a working smoke detector, carbon monoxide detector, working telephone, and First Aid Kit.The home has a fully charged (3A40BC) fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The licensee CPR and First Aid certificate is current and expires (February, 2025). The licensee's mandated reporter training is current and expires (July 2024)


The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on August 31, 2023. (2) Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GOMEZ, BRENDA & MARTINEZ, BELINDA
FACILITY NUMBER: 013421751
VISIT DATE: 09/13/2023
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The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.
The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.
Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov


There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023
LIC809 (FAS) - (06/04)
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