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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300608251
Report Date: 11/06/2024
Date Signed: 11/08/2024 08:50:40 AM

Document Has Been Signed on 11/08/2024 08:50 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GOSSETT, TONIFACILITY NUMBER:
300608251
ADMINISTRATOR/
DIRECTOR:		GOSSETT, TONIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 964-5398
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 11DATE:
11/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Licensee, Toni GossettTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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An unannounced Case Management inspection conducted on this date by Licensing Program Analyst (LPA) Nguyen to provide the facility a copy of an amended LIC 9099 report dated 06/26/2024 and obtain signatures. LPA observed the licensee and an assistant caring for 1 infant and 10 preschool age children. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

Please see "Amended" LIC 9099 report dated 06/26/2024 for corrections.

There were no Title 22 deficiencies cited during today's inspection.

Exit interview was conducted with Licensee, Toni Gossett. Notice of Site Visit was posted during the visit. Licensee was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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