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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400128
Report Date: 06/10/2025
Date Signed: 06/10/2025 01:43:49 PM

Document Has Been Signed on 06/10/2025 01:43 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
198400128
ADMINISTRATOR/
DIRECTOR:		MARTHA LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 507-5702
CITY:DOWNEYSTATE: CAZIP CODE:
90240
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
06/10/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Licensee MarthaTIME VISIT/
INSPECTION COMPLETED:
01:55 PM
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On 6/10/25 Licensing Program Analysts (LPA) Tyler Reyes conducted an Annual/Random inspection at the above facility. LPA met Licensee Martha Lopez and provided an Entrance Checklist-Family Child Care Homes LIC 126. LPA conducted a tour of the facility led by Licensee Martha. LPA observed (5) children in care napping. Hours of operation are Monday-Friday 7:30AM-5:00PM. The facility is approved to care for MAX. CAP (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

During the inspection, the following individuals were present in the home: Licensee Sandra. All adults present in the home have obtained a criminal record clearance or exemption. LPA informed that any individual that has direct contact with the children are required to have a criminal record clearance or exemption.

Facility Postings: LPA observed the required positing in the day care room and backyard: Facility License, PUB 394 Notification of Parents’s Rights, LIC 9148 Earthquake Preparedness, and LIC 610A Emergency Disaster Plan.

Pediatric CPR/First Aid in Pediatrics Certification: Licensee Lopez Expires 10/19/2026 and S1 issued 3/5/25

Emergency Disaster Drill: Earthquake Drill conducted 4/10/24

Facility Sketch: The facility is a single-story structure front yard, dinning room, living room, (3) bedrooms, (2) restrooms, daycare room, laundry area, detached garage, and enclosed backyard.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400128
VISIT DATE: 06/10/2025
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On-limits- Front yard, daycare room, (1) restroom, and backyard.

Off-Limits- Kitchen, Living room, dining room, (3) bedrooms, (1) restroom, laundry area, and garage.

Infants: Per Licensee Martha no infants are currently enrolled. LPA discussed and provided copies of Infant Safe Sleep from California-DSS-Manual and Individual Infant Sleeping Plan LIC 9227

Meals: Per Licensee Martha children will have meals in backyard. Licensee Martha provides meals for children. Licensee Martha was advised to ensure all food brought from home is properly labeled and stored. Per Licensee Martha no children have reported food allergies.

Transportation: Per licensee transportation is provided for children in care. A valid California Driver License for the licensee was observed with an expiration date of 4/5/2029. Per Licensee (2) booster seats are available to use for transportation.

Medication: Per Licensee Martha the facility will provide incidental medical services. If required, medication will be inaccessible to children by centrally storing and locking. Medications will be administered in accordance with PIN 22-02-CCP, which outlines requirements for proper storage, documentation, and staff training. Personal medication centrally stored in off- limit restroom.

The following on-limit areas that will be used by children were inspected for safety, comfort, and cleanliness. LPA observed age-appropriate toys and learning materials. Telephone service is provided via cell phone. LPA observed a fire extinguisher located in living room with a service tag dated 3/3/2025. LPA observed an operable smoke detector and carbon monoxide detector in hallway and daycare room. Heating and cooling are provided by central air conditioning. Poisons will be kept in off-limit garage. Cleaning products are centrally stored in off-limit kitchen. Sharps are centrally stored in off-limit kitchen. There are no firearms on the premises. If firearms are present, LPA informed Licensee of Title 22 regulations that they are locked, with ammunition stored separately. LPA observed fireplace with screen in off-limit living room. Per Licensee fireplace is non-operational

Outdoor: Children are using the backyard for outdoor play. The facility backyard is enclosed. Per Licensee Martha children are supervised during outdoor play. LPA observed that the outdoor yard has toys and other equipment for children to play with. LPA did not observe any objects that could be hazardous to children in care. Facility has no pets. There are no pools or spas, or other bodies of water.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400128
VISIT DATE: 06/10/2025
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Staff Files: LPA reviewed Licensee Martha and S1 which included the following documentation: LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirements to Report Child Abuse, Proof of Immunizations, and Mandated Reporting Training Certificate. (0) of (2) staff had required documentation. Both Licensee Martha and S1 were missing proof of a valid Mandated Reporter Training Certificate. Licensee Martha was missing proof of immunization of Measles. The missing of Mandated Reporter Training Certificate and Measles immunization poses a potential health and safety risk to children in care.

Children Files: LPA reviewed (2) child files, which included the following documentation: LIC 282 Affidavit Regarding Liability Insurance, LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 995A Notification of Parents’ Rights, and LIC 9224 Acknowledgment of Receipt of Licensing Reports it was not applicable. (2) of (2) children had required documentation.

LPA conducted and interview with Licensee Martha regarding the following topics: infant safe sleep practices, the facility’s plan to support children’s learning and development, procedures for keeping parents informed, strategies for managing challenging behaviors, and protocols for managing food allergies. LPA discussed reporting requirement and the Licensee’s responsibilities as a mandated reporter, including the obligation to report to Community Care Licensing and emergency personnel when necessary. LPA provided Licensee Martha with Capacity Ratio for Family Child Care Home License.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400128
VISIT DATE: 06/10/2025
NARRATIVE
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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-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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.

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/.

Licensee 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.

During the exit interview, the LICENSEE Martha, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted and Appeal Rights provided with Licensee Martha. Please see attached LIC 809-D for citations. (2) Type B was issued

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/10/2025 01:43 PM - It Cannot Be Edited


Created By: Tyler Reyes On 06/10/2025 at 01:13 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400128

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above Licensee Martha and S1 did not have a valid Mandated Reporter Training Certificate which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2025
Plan of Correction
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Licnesee Martha will ensure she and all employees have a valid Mandated Reporter Training Certificate. Licensee Martha will provided proof via email of a valid Mandated Reporter Training Certificate.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review , the licensee did not comply with the section cited above Licensee Martha was missing proof of immunization for Measles which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2025
Plan of Correction
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Licensee will ensure herself and all employee have required immunizations on file. Licensee will provide proof of measles by POC Due Date via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Tyler Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2025


LIC809 (FAS) - (06/04)
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