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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842823
Report Date: 09/23/2024
Date Signed: 09/23/2024 02:41:16 PM

Document Has Been Signed on 09/23/2024 02:41 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GOMEZ FAMILY CHILD CAREFACILITY NUMBER:
364842823
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
09/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Ruth GomezTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On date and time listed above, Licensing Program Analyst (LPA) Aman Lama arrived at the facility for a case management-other inspection. On 09/06/24, there was a case management-licensee initiated visit conducted, which resulted in a Type A violation. A determination has been made that the citation cited under section 102425(b)(3), is being dismissed. No deficiency has been cited under section 102425(b)(3). Report dated 09/06/24 has been amended and copy has been given to licensee, Ruth Gomez.

The licensee, Ruth Gomez confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

An exit interview was conducted and report was reviewed with the licensee, Ruth Gomez.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2024
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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