426216201-10-15-2021-17-CC-SMCA-C7TSDM-20211015134722

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216201
Report Date: 10/15/2021
Date Signed: 10/15/2021 01:47:38 PM

Document Has Been Signed on 10/15/2021 01:47 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 FAMILY CHILD CARE		FACILITY NUMBER:	426216201
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	10/15/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Leticia Lopez		TIME COMPLETED:	01:55 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 October 15, 2021 @ 12:00 PM, Licensing Program Analyst (LPA) S. Mendoza-Ceja conducted an announced pre-licensing/change of location inspection with Leticia Lopez (former license #426215942)LPA conducted a risk assessment for COVID-19 prior to the inspection. This is a single-story home which consists of three bedrooms, one bathroom, living room, kitchen, garage and fenced backyard. LPA toured and inspected the entire home with Leticia Lopez. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation. LPA did not observe any cleaning, medications, or toxins accessible to children during the inspection. The garage was observed to be inaccessible to children. LPA observed the backyard to be enclosed by a fence and the play area to be safe appropriate for young children. LPA did not observe any bodies of water on the premises. The areas designated for day care children include the living room (primary day care area), the designated bathroom and backyard. LPA observed the two play pens available for infants. The kitchen area was observed to inaccessible by fencing and have safety latches on the drawers, including the cabinet under the sink; the garage is also inaccessible with the fence in place. In addition, to the fencing making the kitchen off limits applicant has also made medications inaccessible to children in a cabinet above the stove. The off-limit areas are three bedrooms, kitchen and garage. The required fire extinguisher 2A10BC was serviced on 11/17/2020. Applicant is reminded to service the fire extinguisher prior to 11/17/2021. There is smoke detector and carbon monoxide detector in the home which were tested and were operational at the time of the visit. LPA discussed firearms and ammunition. Applicant stated there are no firearms or ammunition in the home. Leticia Lopez has completed the 16 hours of Preventative Health Practices; however, needs to complete the Lead Training. Leticia Lopez did not have verification of current Pediatric First Aid and CPR available for review.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

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 FAMILY CHILD CARE	FACILITY NUMBER: 426216201
	VISIT DATE: 10/15/2021

NARRATIVE

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The following was discussed with the applicant:
· COVID-19 Update Guidance Child Care Programs and Postings for COVID
· Individuals who are 18 years of age or older living in the home or working in the home, must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain the Criminal Record Background Check Clearance for adults who reside or work in the home will result in an immediate civil penalty $100.00 - $3000.00.
· 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 adult/infant CPR & Pediatric First Aid certification, TB clearance, immunization's, and a valid criminal record clearance associated to the facility license.
· A current roster of children enrolled must be available for review and maintained for a period of three years, even after children are no longer attending the facility.
· The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
· Changes in the home should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if applicant moved to another location/ home.
Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements were reviewed and explained.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a Family Child Care Home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, or any other item that falls into that category are not permitted in the facility. · All adults living and working in the home shall be made of aware of the Department inspection rights authority.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

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 FAMILY CHILD CARE	FACILITY NUMBER: 426216201
	VISIT DATE: 10/15/2021

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LPA reviewed Forms/Records to Keep in Your Family Child Care Home with the applicant.

LPA reviewed and provided a copy of the Safe Sleep Regulation 102425. Individual Infant Sleeping Plan (LIC9227), Infant Sleep Chart, and Safe Sleep Frequently asked Questions.
LPA discussed the required postings LIC610A Emergency Disaster Plan, PUB394 Notification of Parents Rights Poster, Facility License, and LIC9213 Notice of Site Visit. In addition, the COVID postings.

Facility Records: LIC 624B Unusual Incident/Injury Report, LIC 9040 Child Care Facility Roster, LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse,
Staff Forms/Records - any assistant present must have the following on file: Proof of TB clearance (within one year), and immunization (MMR, Tdap, and Flu) Notice of Employee Rights (LIC 9052), Criminal Record Statement (LIC 508), Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9180), and AB1207 Child Abuse Mandated Reporter Training.
Children’s records requirements: LIC700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children in Care, Immunization record, PUB 72 Family Child Care Consumer Guide, PUB 515 Effects of Lead Exposure, LIC 995A Notification of Parent’s Rights, and LIC9227 Individual Infant Sleeping Plan.

Applicant was advised how to access forms, regulations and quarterly updates and was informed it is the responsibility of the applicant/licensee to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

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: http://www.ada.gov/childqanda.htm

Prior to licensure: 1) Lead Exposure Training; 2) AB1207 Child Abuse Mandated Reporter Training; 3) Lease Agreement; 4) Updated Facility Sketch (LIC999); 4) Door knobs to be secured to the three bedrooms; and 5) Pediatric CPR and First Aid Training.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

LIC809 (FAS) - (06/04)

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