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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215855
Report Date: 03/07/2023
Date Signed: 03/07/2023 04:27:04 PM

Document Has Been Signed on 03/07/2023 04:27 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: 8CENSUS: 6DATE:
03/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Perla LopezTIME COMPLETED:
02:00 PM
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On March 7, 2023 at 11:31 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced One (1) Year Required inspection at the above Family Child Care Home (FCCH) LPA asked pre- screening questions related to COVID- 19 and licensee’s responses indicate there are no COVID -19 exposure on site. LPA met with licensee, Perla Lopez and explained the purpose of the inspection. There were 4 children present at the time of the inspection. On or about 12:10 PM, Licensee with day children left to pick up 2 school age children. LPA left and came back at 12:45 PM as soon as Licensee arrived.

LPA in the company of Licensee toured the FCCH. Required licensing forms are posted in the wall. LPA observed age appropriate toys, books and equipment. LPA observed smoke and carbon monoxide detectors in the FCCH. The fire extinguisher was purchased on 3/5/2023. Licensee was reminded that fire extinguisher should be serviced or to purchase a new one every year. FCCH conducts fire and disaster drill every 3 months, last drill was conducted on 1/17/2023. Bathroom was observed to be clean and free of toxins. Hazardous items and cleaning materials are kept inaccessible to day care children. The day care children use the apartment play ground where complete physical and visual supervision are required. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home.

LPA reviewed facility file, Pediatric CPR and First Aid expires on 6/11/2024. Licensee's Mandated Reporter Training expired on 10/15/2022 Licensee was reminded to renew Mandated Reporter Training every 2 years. A sampling of children records were reviewed and found complete. It contains Emergency and Identification card. Parents signed the LIC 9150 Parent Notification of Additional Children in care. FCCH has current children's roster. Licensee checks the napping infants every 15 minutes but not documenting it.


Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 03/07/2023
NARRATIVE
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Licensee does not provide Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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: http://www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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

During today's inspection, deficiency was cited and Technical violation was issued. Appeal Rights were given and discussed.

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted and report was reviewed with the licensee, Perla Lopez.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
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Document Has Been Signed on 03/07/2023 04:27 PM - It Cannot Be Edited


Created By: Gigi Reyes On 03/07/2023 at 12:05 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LOPEZ FCC AKA HAPPY TRIBE
FACILITY NUMBER: 406215855

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023

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 record review, the licensee did not comply with the section cited above, Licensee did not renew her Mandated Reporter Training which expired on 10/15/2022, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/27/2023
Plan of Correction
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Licensee shall renew the r Mandated Reporter Training and submit proof to Community Care Licensing no later than March 27, 2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


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