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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493331
Report Date: 04/06/2022
Date Signed: 04/07/2022 10:38:40 AM

Document Has Been Signed on 04/07/2022 10:38 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:GOMEZ DE ARCEO FAMILY CHILD CAREFACILITY NUMBER:
197493331
ADMINISTRATOR:GOMEZ DE ARCEO, MARTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 983-3002
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
04/06/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Martina Gomez De ArceoTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Veronica Wheatley conducted an unannounced case management inspection and met with the licensee Martina Gomez De Arceo and husband Arturo Arceo.

During an inspection, LPA observed three children present at the day care who are enrolled and do not have a complete file. Licensee states that the children started last week and attended one day last week.

LPA informed licensee that day care children must have a complete file in order to be on the day care premises.

An exit interview was conducted. A copy of the report will be emailed to the licensee at atreyu47@yahoo.com.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2022
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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Document Has Been Signed on 04/07/2022 10:38 AM - It Cannot Be Edited


Created By: Veronica Wheatley On 04/06/2022 at 01:36 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GOMEZ DE ARCEO FAMILY CHILD CARE
FACILITY NUMBER: 197493331

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/07/2022
Section Cited
CCR
102421(b)

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102421(b) - Child's Records-The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7).
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The licensee was informed the requirement to have a complete file for children enrolled. The licensee will inform the parent to submit required paperwork in order for the children to be on the premises. Licensee will submit plan of correction to the department by 4/722
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LPA V. Wheatley reviewed records and did not observe a required file for Child #1, Child #2 and Child #3. This is a potential hazard to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maureen Neal
LICENSING EVALUATOR NAME:Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022


LIC809 (FAS) - (06/04)
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