364846627-8-13-2024-09-CC-TBEN-D84NGU-20240813102742

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364846627
Report Date: 08/13/2024
Date Signed: 08/13/2024 10:27:52 AM

Document Has Been Signed on 08/13/2024 10:27 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	GOMEZ CASTILLO FAMILY CHILD CARE		FACILITY NUMBER:	364846627
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/13/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:25 AM
MET WITH:	Sandra Gomez Castillo, Applicant		TIME VISIT/ INSPECTION COMPLETED:	10:35 AM

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 date and time listed, Licensing Program Analysts (LPAs) Taityana Benson and Samuel Lopez arrived at the facility to conduct a pre-licensing inspection. The Applicant, Sandra Gomez Castillo requested Spanish speaking. LPA Lopez translated the visit in Spanish. LPAs toured the facility, inside and out and the following was observed and/or discussed: Normal days and hours of operation are: Monday - Friday, 6:00 a.m. – 6:00 p.m. OFF-LIMIT AREAS INCLUDE: Garage ·Appropriate fire extinguisher, smoke detector and carbon monoxide detector are present and were tested by the applicant during this inspection. Fire extinguisher, smoke detector and carbon monoxide detector are in working order. ·All hazardous items are inaccessible ·Toxins are locked in the garage ·No guns or weapons present as of this date per Applicant, Sandra Gomez Castillo. Applicant understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations. ·Single Story Residence ·Storage of poisons are inaccessible to children and locked in the garage · The Applicant, Sandra Gomez Castillo provided proof of control of property (Lease Agreement) · Because the Applicant, Sandra Gomez Castillo rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Report Continued On LIC809-C

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GOMEZ CASTILLO FAMILY CHILD CARE	FACILITY NUMBER: 364846627
	VISIT DATE: 08/13/2024

NARRATIVE

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·Facility Sketch, Emergency Disaster Plan, PUB 394 Notification of Parents Rights, LIC 9148, and Earthquake Preparedness are posted.
·Mandated Reporter Training completed on 06/16/2024 (General and Child Care Providers AB1207)
·Pediatric CPR and First Aid Card - expire on 05/29/2025
·Health & Safety Certificate - completed on 05/25/2022
·Applicant understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.
·Clean, safe and age appropriate toys
·There are no toxic plants observed at this time
·The Applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
·Resident and/or staff records reviewed on 08/13/2024 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
·The Applicant can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

The following was discussed with the applicant(s):

- Pre-Licensing Visit Packet provided
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months
- Responsibilities of being a mandated reporter
- Responsibility to know the regulations for anyone providing care
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility’s phone numbers must always be on file with the licensing office
- Baby walkers, baby-bouncer, and walker-jumpers are prohibited (16 CFR 1500.86(a)(4))

Report Continued On LIC809-C

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GOMEZ CASTILLO FAMILY CHILD CARE	FACILITY NUMBER: 364846627
	VISIT DATE: 08/13/2024

NARRATIVE

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LPA reviewed with Applicant, Sandra Gomez Castillo the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with Applicant, Sandra Gomez Castillo and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource.

LPA also informed Applicant, Sandra Gomez of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Applicant, Sandra Gomez was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Applicant, Sandra Gomez Castillo was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GOMEZ CASTILLO FAMILY CHILD CARE	FACILITY NUMBER: 364846627
	VISIT DATE: 08/13/2024

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A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at: https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at: 951-782-4200.

Before licensure, the following needs to be corrected/completed:
1. Provide Proof of Control of Property: Current Lease Agreement

Once all corrections have been verified, the application for a Small Family Child Care Home will be submitted for approval with a maximum capacity: 6– No more than 3 or 4 infants only. Capacity 8 – no more than 2 infants, 1 Child in kindergarten or elementary school and 1 child at least age 6.

The Applicant, Sandra Gomez Castillo, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.
Exit interview conducted and report was reviewed with the Applicant, Sandra Gomez Castillo.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC809 (FAS) - (06/04)

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