198400128-1-18-2023-54-CC-MRIA-CN83TU-20230118173231

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400128
Report Date: 01/18/2023
Date Signed: 01/18/2023 05:32:49 PM

Document Has Been Signed on 01/18/2023 05:32 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	LOPEZ FAMILY CHILD CARE		FACILITY NUMBER:	198400128
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 3	DATE:	01/18/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	03:09 PM
MET WITH:	Martha Lopez, Licensee		TIME COMPLETED:	05:35 PM

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 Wednesday, January 18, 2023, at 3:09 p.m., Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced case management for capacity increase and met with licensee Martha Lopez who guided LPA Rivera on a tour of the facility. The licensee is requesting to increase her capacity to a large license. A fire clearance has been granted as of 12/8/22 for capacity of 14. Family members residing in the home has been discussed with applicant and are cleared. Operating hours will be Monday to Friday from 7:30 a.m. to 6:00 p.m. and care for children ages 0 to 13. This facility is a one-story home that consists of 3 bedrooms, 2 full restrooms, kitchen, dining room, living room, den (daycare area), front and backyard. All areas identified on the facility sketch were inspected. Areas that are accessible to children and identified on the facility sketch include; living room, den, restroom located in the den, and backyard. Areas off limits to children include- three bedrooms, bathroom located next to the master bedroom, dining room, kitchen and front yard. To avoid children entering the bedrooms, LPA observed the doors closed with a key lock doorknob and a anchored safety gate between the living room and dining to prevent children entering the area. During this inspection, LPA observed 2 infants, 1 toddler and assistant present. At approximately 3:17 p.m LPA Rivera inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone) . For ventilation, LPA Rivera observed a central AC/heater and the vents located on the ceiling walls. LPA observed the furniture, children materials, cribs and playpens to be in good condition and age appropriate. Ill/isolation area located in the corner of the daycare room.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 198400128
	VISIT DATE: 01/18/2023

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
26
27
28
29
30
31
32

At approximately 3:22 p.m., LPA Rivera entered the restroom and observed the toilet, hand washing sink, and soap. LPA observed the bottom sink cabinet closed and with a childproof lock. LPA did not observe hazard materials and observed the restroom to be in good condition.

At approximately 3:28 p.m. LPA Rivera observed cleaning compounds items stored inside the laundry room located outside patio. LPA observed the door closed and locked. LPA observed knives and sharp objects stored inside the top kitchen cabinet making it inaccessible for children to reach. For water drinking LPA observed a water jug. Licensee provides the meals and is enrolled with the California Adult Child Care Food Program. Licensee currently has no children with food allergies.

LPA Rivera asked licensee if there are any pets, poisons, firearms, weapons or bodies of water. Licensee stated she has no pets, no body of waters, firearms, weapons or poisons. LPA did not observe, pets, firearms, weapons, poisons nor bodies of water. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.

At approximately 3:35 p.m. LPA Rivera observed the required 2A10BC fire extinguisher located in the living room with the valve on the green area indicating fully charged and purchased receipt dated 12/05/22. LPA observed carbon monoxide detector located in the hallway and the smoke detectors in the living room and den. LPA Rivera tested the carbon monoxide and smoke detectors. Carbon and smoke detectors are operable. LPA observed the first Aid complete with band aids, gauzes, adhesive bandages and antiseptic wipes and located in the den.

At approximately 3:47 p.m., LPA Rivera inspected the outdoor area used by children for safety, comfort and cleanliness. LPA observed the yard to be fenced all around and the equipment to be age appropriate, and good condition and free of sharp, no loose or pointed parts. LPA observed a guest house in the back of the backyard gated with a self-latch gate.

LPA observed licensee Pediatric First Aid/ CPR certification dated 11/5/22, Health and Safety certification dated 11/8/2019 and licensee has proof of immunization against Pertussis, MMR and Influenza declination. Licensee has completed the mandated reporter (AB 1207) training dated 5/26/21. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 198400128
	VISIT DATE: 01/18/2023

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
26
27
28
29
30
31
32

LPA observed the required postings LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, LIC 999 Facility sketch, and child car seat law poster.

The following was also discussed with licensee:
1. In the absence of the licensee a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current Pediatric first aid/ CPR-adult-child- infant certification and a valid criminal record clearance associated to the facility license.

2. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

4. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.

5. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

6. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

7. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

9. Smoking is prohibited in the family childcare home.

10. Children and staff records must be maintained and updated as needed and be available for review by the Department.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 198400128
	VISIT DATE: 01/18/2023

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
26
27
28
29
30
31
32

11. Dog(s) and/or pets are recommended to be isolated from children in care.

12. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, and any other item that falls into this category is not permitted in the facility.

Criminal Record Statement
Licensee Martha Lopez 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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Safe Sleep
LPA discussed the safe sleep regulations with licensee Martha Lopez 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 licensee Martha Lopez 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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: http://www.ada.gov/childqanda.htm
The facility currently has no children with or on medication.

No citations were given during this visit. A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. An exit interview was conducted; report and appeal rights were given and reviewed with licensee Martha Lopez.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4