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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700108
Report Date: 06/03/2021
Date Signed: 06/03/2021 04:02:47 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/03/2021 04:02 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LOPEZ, ESTELLAFACILITY NUMBER:
015700108
ADMINISTRATOR:LOPEZ, ESTELLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 518-0606
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
06/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Estella LopezTIME COMPLETED:
04:20 PM
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On 06/03/2021 at 2:00pm, Licensing Program Analyst (LPA) Jonathan Williams met with Licensee (Estella Lopez) for a Required 1 Year Inspection. Present for this inspection are the Licensee, one fingerprint-cleared and associated assistant provider, and 10 children in care (three infants and seven preschoolers). The facility was toured to conduct a Health and Safety Inspection. Facility operating hours are 7:30am-5:30pm M-F.

The home is a 1 story home rented by the Licensee and is tidy and clean with heating and ventilation for safety and comfort. Ample play equipment and learning material was observed throughout the inspection to be present in the home and play equipment was observed to be age-appropriate and free of defects or dangerous conditions at this time. No cleaning compounds, poisons, toxins, or detergents were observed to be accessible to children during the inspection.

ON LIMIT AREAS are living room, dining room, kitchen, family room, bathroom 1, play yard.
OFF LIMIT AREAS are bedrooms 1-4, garage, bathroom 2, and off-limits yard, all of which will be made inaccessible to children by closed and/or locked doors, barricade, and visual supervision.
ISOLATION ROOM is the living room.

The backyard is fenced. There are no pools, hot tubs, ponds, or any other bodies of water in the on-limits areas during today's inspection. Per Licensee statement at 3:10pm, there are no firearms kept in the home. LPA observed a dog to be present in an off-limits bedroom, and Licensee stated that the dog is never allowed to be around children. LPA observed immunization records for the dog at 3:16pm. There is a fireplace in the home which LPA observed at 3:17pm to be barricaded to prevent access to children.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2021
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LOPEZ, ESTELLA
FACILITY NUMBER: 015700108
VISIT DATE: 06/03/2021
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The facility was observed at 2:45pm to have a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Licensee has current CPR/1st Aid training which expires on 01/18/2022. Mandated Reporter Training for Licensee expired on 05/01/2021. The facility is in ratio today. Children's files were reviewed for proper documentation. Facility roster was obtained.

Individual Medical Services (IMS) policy was discussed. This facility does not provide IMS to children in care. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (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.”

Licensee was reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.
Licensee was reminded that California Law requires licensed Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the Licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

There are no deficiencies cited. This report shall remain on file for 3 years. A Notice of Site Visit was provided to the Licensee. LPA reminded the Licensee to post the Notice of Site Visit where it is clearly visible inside the facility for 30 days. Appeal rights were provided to the Licensee. Exit interview was conducted at 3:48pm.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
LIC809 (FAS) - (06/04)
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