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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197405591
Report Date: 08/29/2023
Date Signed: 08/29/2023 03:07:50 PM

Document Has Been Signed on 08/29/2023 03:07 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
197405591
ADMINISTRATOR:LOPEZ, MARIA & ALMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 673-3398
CITY:LENNOXSTATE: CAZIP CODE:
90304
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
08/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mariaestella Lopez TIME COMPLETED:
03:10 PM
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On 8/29/2023 Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection at 4228 W. 107th Street, Lennox, CA 90304. During today’s inspection was licensees M. Lopez and A. Lopez with 2 children providing care and supervision. Inspection was completed in Spanish and English.

The hours of operation are Monday – Friday 7:30 a.m. to 5:30 p.m. LPA toured the home inside and outside and reviewed facility sketch. Currently facility is available to take children ages birth to 12 years old. Home has children ages 2 years old to 11 years old enrolled in the program. Facility is licensed for a Large family Child Care license with a max capacity of 14 children. Licensee is NOT available for evening, overnight care or weekend care.

This is a duplex with a front unit and back unit. Licensed home is the front unit. The licensee’s home consists of 3 bedrooms, 3 bathroom, kitchen, dinning room, living room, changing room and play room. Child care is conducted in the playroom located in the rear of the home. Bathroom that children use is located outside the playroom. LPA observed the changing room with a changing table and children's cubbies where children store their personal belongings. Living room and dining room area are used occasionally for day care.

Licensee confirmed the following areas as OFF LIMITS: bedroom 1, bedroom 2, bedroom 3, bathroom 2 bathrooms. Parents enter through the side gate of the home and enter directly to the play room. The rest of the home is OFF LIMITS and children do not have access to the bedrooms. LPA reminded licensees that any area designated as OFF LIMITS should be made inaccessible during the hours of operation and/or while children are present.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 197405591
VISIT DATE: 08/29/2023
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Enclosed front yard was observed and inspected. Age appropriate outdoor toys were observed and inspected. High climbing structures and/or swings were observed with soft cushioning material.


There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds are kept in the back of the home, area inaccessible to the children in care.

Licensee confirmed that home is available to take in a child that might need medication, currently home does not have any child that needs medication administer. LPA reminded licensee to ensure that all necessary documents are kept on file and medication is always in its original packaging.

LPA observed licensee test the carbon monoxide and smoke detector in the home. LPA observed 2 working fire extinguisher in the play room . Licensee confirmed that home provides meals and snacks and is currently participating in the local food program. LPA discussed the importance of maintaining a system where allergies and food restrictions are noted.

Adequate heating and ventilation for safety and comfort were observed in the space. Safe toys and play equipment were observed. The home has working telephone service and LPA confirmed the phone number 310-673-3398.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

Capacity as specified on the license is being maintained during today’s inspection.

Safe Sleep regulations were discussed due to program being available for infant care. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 197405591
VISIT DATE: 08/29/2023
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documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Infants up to 12 months of age are placed on their backs for sleeping. Individual Infant Sleeping Plan was discussed and LIC form was reviewed.

LPA reviewed licensee’s file and observed file was complete. Mandated Reporter training was not available for review. Licensees’ CPR and First Aid Certification was observed with an expiration date of 6/2024. LPA reminded licensee the importance of making sure all vendors providing CPR and Pediatric CPR need to be EMSA approved.

LPA discussed all necessary forms needed in each staff file and children’s file. LPA provided licensee with a current copy of the LIC 311D to use as a reference when auditing files. LPA reviewed 2 children’s files and observed files to be complete.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee 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.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 197405591
VISIT DATE: 08/29/2023
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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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensees, Mariaestela Lopez and Alma R. Lopez, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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

Exit interview conducted and report was reviewed with Licensees, M. Lopez and A. Lopez.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
LIC809 (FAS) - (06/04)
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