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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215855
Report Date: 08/20/2021
Date Signed: 08/20/2021 03:09:59 PM

Document Has Been Signed on 08/20/2021 03:09 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:LOPEZ FCC AKA HAPPY TRIBEFACILITY NUMBER:
406215855
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
08/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Perla LopezTIME COMPLETED:
03:20 PM
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On 8/20/21 at 1:45 PM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Required Inspection of the facility. Prior to entering the facility, LPA conducted pre-screening COVID-19 questionnaire and based on Licensee’s responses it was determined that the facility is safe and free from any COVID-19 exposures. LPA meet with Perla Lopez, Licensee of the facility and explained the purpose of the inspection. LPA in the company of the Licensee, toured the interior of the home. This apartment consists of three (3) bedroom, two (2) bathrooms. Licensee stated that living room, kitchen area, bathroom in the hallway are accessible to the children in care. While all bedrooms are inaccessible to the children in care by a small safety gate. During the time of the inspection, Licensee was caring for four (4) children. Licensee’s adult son was present in the facility along with Licensee’s teenage daughter.

LPA observed required forms posted in the wall as you enter the facility. LPA observed a combination smoke and carbon monoxide detector in the hallway of the facility. Detector was tested by Licensee and found to be operational at 1:56 PM. The home has a regulation fire extinguisher which was serviced on 11/12/20. LPA reminded Licensee that fire extinguisher needs to be either service or purchase annually. The home maintains working telephone services.

LPA observed all cleaning supplies and toxins are stored in a closet located in the hallway. Closet is made inaccessible by small gate making hallway inaccessible to children. Children have access to the hallway when using the restroom. Per Licensee, children are always supervised when using the restroom. LPA observed that Licensee stores sharps in a high cabinet in the kitchen that are inaccessible to children in care. The facility has proper ventilation for child care services. Facility kitchen had dishes piled up and trash can was filled to the top with no lid. The restroom used for children was found to be orderly and has plenty of hand soap, paper towels. Restroom is pending hand washing poster accessible to children in care. Medication in the facility is stored in a high cabinet in the kitchen and are inaccessible to children. Toys and equipment observed in the facility are age appropriate. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: LOPEZ FCC AKA HAPPY TRIBE
FACILITY NUMBER: 406215855
VISIT DATE: 08/20/2021
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Licensee stated that children have access to a small play yard located in the apartment complex. Licensee shared that when she takes children outside to play, there is always adult supervisor. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the facility.

A sampling of the children's record was reviewed and found to have current and up to date with emergency information cards. The Licensee's records indicate Mandated Reporter training certificate expires 10/15/22. LPA reminded Licensee that AB1207 must be updated every two years. Licensee’s CPR and First Aid certifications expires on 6/20/22. LPA review emergency drill log and observed the last emergency drill was conducted and documented today 6/28/21. LPA reminded Licensee that emergency drills are required every six (6) months and need to be documented.

The Licensee is not providing Incidental Medical Services (IMS). Policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: www.ada.gov/childqanda.htm

LPAs discussed COVID 19 guidance and best practices with the Licensee. Licensee was reminded that it is Licensee's responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov. LPA and Licensee discussed safe sleep regulations. LPA provided a copy of new Safe Sleep Regulations and LIC 9227 Individual Infant Sleep Plan for Licensee to review. Licensee currently has one (1) infant age children enrolled for services.

In areas evaluated, there were no deficiencies cited during today's visit. Licensee will secure safety gate by the hallway in the facility and will add door safety knobs to the bedrooms in the home. Licensee shared that she will deep clean this weekend.

LPA provided Licensee with Notice of Site visit (LIC 9213) which was posted by the Licensee.

This inspection and revision of report was conducted in Spanish due to it being Licensee's primarily language.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
LIC809 (FAS) - (06/04)
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