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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019948
Report Date: 02/08/2024
Date Signed: 02/12/2024 01:01:54 PM

Document Has Been Signed on 02/12/2024 01:01 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
198019948
ADMINISTRATOR:MAURA LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 201-1853
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
02/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Maura LopezTIME COMPLETED:
12:15 PM
NARRATIVE
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On February 8, 2024 at 9:20 am. Licensing Program Analyst (LPA) Carolyn Tuba conducted a Case Management inspection due to an incident that occurred at the facility on 1/19/2024. LPA met with Licensee, Maura Lopez. LPA conducted interviews and obtained documentation. The incident was reported to the Department within the required 24 hours of occurrence. The incident consisted with a child having an injury that required medical attention.

Based on all the information obtained, interviews conducted with Licensee, her Assistant who observed the incident and the parent of the child. LPA determined that the incident was an accident. The LPA was unable to interview the child due to their age and not verbal enough. The Child has recovered after the injury and returned to the facility. LPA obtained a copy of the medical report and the incident report given to the parent at the time of injury. LPA took photo of the chair, the child was climbing. LPA viewed video of child the day of the incident. During the course of the visit, LPA’s computer was not working properly and a manual LIC809 was given no deficiencies were cited today.

A manual Notice of Site Visit was given and remain posted for 30 days.

Exit interview conducted & report was reviewed with Licensee, Maura Lopez.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2024
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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