<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300608251
Report Date: 04/04/2024
Date Signed: 04/04/2024 11:34:55 AM

Document Has Been Signed on 04/04/2024 11:34 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GOSSETT, TONI & GARYFACILITY NUMBER:
300608251
ADMINISTRATOR/
DIRECTOR:		GOSSETT, TONIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 964-5398
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
04/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:11 AM
MET WITH:Licensee Toni GossettTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 04/04/2024, Licensing Program Analyst (LPA) Romy Castanon conducted a Case Management due to deficiencies observed during today's inspection. LPA Castanon met with Licensee Toni Gossett. LPA observed 7 daycare children, Assistant #1 and Assistant #2.

A review of the Facility Personnel Report Summary on 04/04/2024 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During LPA’s tour of the facility, LPA observed an infant on a video monitor and requested to see the infant. Licensee led LPA to the downstairs master bedroom. LPA observed the bedroom door closed. The location of the play yard was by the entrance, on the left side of the room. LPA observed the infant laying on a Fisher-Price bassinet that was placed inside a play yard/playpen. LPA provided Licensee with copy of
PIN 20-24-CCP, safe sleep regualtions 102425 and safe sleep handout. For more resources, Licensee was provided the department's safe sleep website: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

Based on LPA’s observation and interview with Licensee, the facility is receiving two citations in accordance with California Code of Regulations, Title 22, Division 12, Section 102425 Infant Safe Sleep.

Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Tony Gossett. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee shall have LIC9224 (Acknowledgement of Receipt) signed and kept in each child's file. (End of Report)
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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 3
Document Has Been Signed on 04/04/2024 11:34 AM - It Cannot Be Edited


Created By: Romelia M Castanon On 04/04/2024 at 10:39 AM
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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GOSSETT, TONI & GARY
FACILITY NUMBER: 300608251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/05/2024
Section Cited
CCR
102425(b)

1
2
3
4
5
6
7
102425 Infant Safe Sleep ...(b) Cribs or play yards shall be free from all loose articles and objects.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee removed the bassinet during LPA's visit. Licensee will review safe sleep regulations and include assistants. Licensee will submit signed documentation by all facility staff stating they reviewed regulations by POC date.
8
9
10
11
12
13
14
Based on LPA's observation, Infant #1 was laying in a Fisher-Price bassinet that was placed inside a play yard/playpen. This poses an immediate risk to the health, safety or personal rights of the persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Patricia Magana
LICENSING EVALUATOR NAME:Romelia M Castanon
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/04/2024 11:34 AM - It Cannot Be Edited


Created By: Romelia M Castanon On 04/04/2024 at 10:49 AM
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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GOSSETT, TONI & GARY
FACILITY NUMBER: 300608251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
04/12/2024
Section Cited
CCR
102425(5)(A)

1
2
3
4
5
6
7
(5) If the infant is sleeping in a separate ... door to the room the infant is sleeping in shall remain open
at all times.
(A) The provider shall be able to visually observe the infant without
moving the door. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
During LPA's visit, Licensee moved the play yard directly in front of the door and kept the door open for the remainder of the visit. Licensee states when an infant is resting, they will keep the bedroom door open and the infant in their line of sight. Licensee will review safe sleep regulations and submit documentation stating they have reviewed it.
8
9
10
11
12
13
14
Based on LPA's observations, infant #1 was resting in the downstairs master bedroom on the left side of the room. The bedroom door was closed. This poses an potential heath, safety, or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Patricia Magana
LICENSING EVALUATOR NAME:Romelia M Castanon
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3