<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216201
Report Date: 10/11/2022
Date Signed: 10/11/2022 03:02:15 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/11/2022 03:02 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 CAREFACILITY NUMBER:
426216201
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
10/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Leticia LopezTIME COMPLETED:
03:30 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 11th at 9:21 AM, Licensing Program Analyst (LPA) Rosie Breault conducted an unannounced Required/ Annual Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Leticia Lopez, licensee of the FCCH and explained the purpose of the inspection. LPA conduced a Covid-19 prescreening and licensee indicated no exposure on site. Present also was licensee’s daughter Fatima Landeros, assisting in translation for a short period. In addition, licensee submitted documentation for a change of capacity. As such, the change of capacity request will be addressed during the inspection. LPA, in the company of the licensee, toured the interior and exterior of the FCCH. This is a one-story home with living room being used as playroom, dining room, and outdoor play area. Pre-licensing report indicates kitchen is off limits; however, licensee had kitchen area open and accessible. The remainder of the home is inaccessible to children. Bathroom is not being used as all children under care and supervision are infants. At the time of the inspection, LPA observed four (4) children in care along with Fatima (daughter, not fingerprinted and cleared) providing supervision. Also present in the home was licensee’s second daughter, under the age of 18.

CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2022
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 9
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: 10/11/2022
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 required licensing forms and documents post on the wall in playroom. LPA observed a combination smoke/carbon monoxide. The detector was tested at 9:49AM and found to be operable. LPA observed a regulation fire extinguisher in the FCCH which was serviced on 1/29/2022. LPA reminded the licensee to either service or purchase a regulation fire extinguisher annually. LPA notes a screened fireplace in the interior of the home which is excluded from care and inaccessible to children. Licensee indicated last fire drill was roughly two weeks ago; however, Licensee stated there was no fire drill log present in the home. This is in violation of Title 22, Division 12; 102417 (9) (A) (1). A Type B deficiency will be cited on corresponding LIC809D. Licensee stated no firearms or ammunition are present in the home.

LPA observed the FCCH to be clean. LPA observed toxins (Febreze, carpet cleaning solution and other compounds) under the kitchen sink with no lock present, accessible to children in care. This is in violation of Title 22, Division 12; 102417 (G) (4). This poses and immediate risk to children in care. A Type A deficiency will be cited on corresponding LIC809D. LPA observed knives and sharp objects in a drawer in the kitchen sink not locked and under 5 feet in height. This is in violation of Title 22, Division 12; 102417 (G) (4). This poses and immediate risk to children in care. A Type A deficiency will be cited on corresponding LIC809D. LPA observed scissors (metal with plastic handle and curvy edges) present in the changing station accessible to children’s reach. This is in violation of Title 22, Division 12; 102417 (G) (4). This poses and immediate risk to children in care. A Type A deficiency will be cited on corresponding LIC809D.

CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
Page: 2 of 9
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: 10/11/2022
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
The FCCH's outdoor play area's has age appropriate toys and play equipment for children to use and there is ample shade of children. LPA observed side area gate unlocked with access to an open shed. LPA observed a second outdoor metal sectioning divider open with accessibility to barbeques and gym equipment. These are in violation of Title 22, Division 12; 102417 (6) This poses and immediate risk to children in care. A Type A deficiency will be cited on corresponding LIC809D. There are no bodies of water present.

LPA reviewed three out of the four present children’s records. Licensee indicated she did not have records for C4, as she provided them to the parent(s) two months ago and parents have not returned them. This is in violation of Title 22 Division 12 102421 and a Type B deficiency will be cited. Remaining records for children were incomplete. Licensee did not have her records or records for FCCH. This is a violation of Title 22 Division 12 102416.1 (a). A Type B deficiency will be cited. Licensee provided Pediatric First Aid/CRP which expired on 8/22/2022. This is a violation of Division 12 Title 22 (1) (a). A Type B deficiency will be assessed. Licensee did not have a Mandated Reporter Training Certificate available for inspection; however current one is on file to be expired 10/15/2023.

LPA confirmed daughter Fatima Landeros is not fingerprinted and cleared. Daughter indicates she is in the process of being fingerprinted. She has been assisting her mother for roughly six months. Informed licensee and daughter this an immediate Type A Violation with a civil penalty of $500.00 to be assessed. LPA reminded daughter, until cleared, she may not assist licensee in any capacity, and daughter exited FCCH.

CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
Page: 3 of 9
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: 10/11/2022
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
The Licensee is not providing Incidental Medical Services (IMS). Policy was discusses, 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

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.


Licensee is reminded that it is Licensee’s responsibility to know the regulations for a FCCH which can be accessed on-line at www.ccld.ca.gov.

CCLD received a fire clearance for the issuance of a large FCCH license on 9/25/2022 from Lompoc Fire. In view of the current inspection the facility the request for the increase has been denied at this time pending manager approval. Licensee is to set forth current small FCCH to be compliance with all rules and regulations prior to issuance of large licensure.

809D, Civil Penalty, Appeal Rights and LIC9224 to licensee.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817.

Exit interview conducted.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
Page: 4 of 9
Document Has Been Signed on 10/11/2022 03:02 PM - It Cannot Be Edited


Created By: Maryrose Breault On 10/11/2022 at 01:37 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 FAMILY CHILD CARE
FACILITY NUMBER: 426216201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/11/2022
Section Cited
CCR
102417(g)(4)

1
2
3
4
5
6
7
Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
1
2
3
4
5
6
7
Licensee is requested to attend a meeting in the Goleta Regional Office to discuss prior deficience and other health and safety concerns. Licensee will be notified by mail of date and time.
8
9
10
11
12
13
14
This is evidenced by:
LPA observed toxins under sink accessible to children, LPA observed knives and sharp objects accessible to children. LPA observed scissors present in diaper changing area.
8
9
10
11
12
13
14
Type A
10/11/2022
Section Cited
CCR102417(6)

1
2
3
4
5
6
7
Outdoor play areas shall be either fenced, or outdoor play shall be supervised by the licensee or caregiver.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
This is evidenced by:
LPA observed two outdoor fences open and unlocked rendering them accessible to children.
8
9
10
11
12
13
14
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:Ana Tolentino
LICENSING EVALUATOR NAME:Maryrose Breault
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022


LIC809 (FAS) - (06/04)
Page: 5 of 9
Document Has Been Signed on 10/11/2022 03:02 PM - It Cannot Be Edited


Created By: Maryrose Breault On 10/11/2022 at 01:59 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 FAMILY CHILD CARE
FACILITY NUMBER: 426216201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/11/2022
Section Cited
CCR
102370(d)

1
2
3
4
5
6
7
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility.
1
2
3
4
5
6
7
Licensee is requested to attend a meeting in the Goleta Regional Office to discuss prior deficience and other health and safety concerns. Licensee will be notified by mail of date and time.
8
9
10
11
12
13
14
This is evidenced by:
LPA confirmed daughter, over the age of 18, is acting in assisting capacity without fingerprint clearance.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Ana Tolentino
LICENSING EVALUATOR NAME:Maryrose Breault
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022


LIC809 (FAS) - (06/04)
Page: 6 of 9
Document Has Been Signed on 10/11/2022 03:02 PM - It Cannot Be Edited


Created By: Maryrose Breault On 10/11/2022 at 02:04 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 FAMILY CHILD CARE
FACILITY NUMBER: 426216201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2022
Section Cited
CCR
102417(9)(A)(1)

1
2
3
4
5
6
7
The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family childcare home
1
2
3
4
5
6
7
Licensee is requested to attend a meeting in the Goleta Regional Office to discuss prior deficience and other health and safety concerns. Licensee will be notified by mail of date and time.
8
9
10
11
12
13
14
This is evidenced by:
Licensee did not have a recent fire drill on record
8
9
10
11
12
13
14
Type B
10/11/2022
Section Cited
CCR102425(b)

1
2
3
4
5
6
7
Cribs or play yards shall be free from all loose articles and objects.
1
2
3
4
5
6
7
Licensee is requested to attend a meeting in the Goleta Regional Office to discuss prior deficience and other health and safety concerns. Licensee will be notified by mail of date and time
8
9
10
11
12
13
14
This is evidenced by:
LPA observed one crib with child present that had plastic balls and book.
8
9
10
11
12
13
14
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:Ana Tolentino
LICENSING EVALUATOR NAME:Maryrose Breault
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022


LIC809 (FAS) - (06/04)
Page: 7 of 9
Document Has Been Signed on 10/11/2022 03:02 PM - It Cannot Be Edited


Created By: Maryrose Breault On 10/11/2022 at 02:16 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 FAMILY CHILD CARE
FACILITY NUMBER: 426216201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2022
Section Cited
CCR
102416.1(d)

1
2
3
4
5
6
7
All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.
1
2
3
4
5
6
7
Licensee is requested to attend a meeting in the Goleta Regional Office to discuss prior deficience and other health and safety concerns. Licensee will be notified by mail of date and time.
8
9
10
11
12
13
14
This is evidence by:
Licensee could not provide any personnel or facility files to LPA during inspection.
8
9
10
11
12
13
14
Type B
10/11/2022
Section Cited
CCR102421(a)

1
2
3
4
5
6
7
The licensee shall maintain, in each child's record, the signed and dated notice...
1
2
3
4
5
6
7
Licensee is requested to attend a meeting in the Goleta Regional Office to discuss prior deficience and other health and safety concerns. Licensee will be notified by mail of date and time.
8
9
10
11
12
13
14
This is evidenced by:
Licensee could not provide LPA entire records for one child in care.
8
9
10
11
12
13
14
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:Ana Tolentino
LICENSING EVALUATOR NAME:Maryrose Breault
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022


LIC809 (FAS) - (06/04)
Page: 8 of 9
Document Has Been Signed on 10/11/2022 03:02 PM - It Cannot Be Edited


Created By: Maryrose Breault On 10/11/2022 at 02:21 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 FAMILY CHILD CARE
FACILITY NUMBER: 426216201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2022
Section Cited
CCR
102416(c)(1)

1
2
3
4
5
6
7
The training shall include pediatric cardiopulmonary resuscitation, pediatric first aid,
1
2
3
4
5
6
7
Licensee is requested to attend a meeting in the Goleta Regional Office to discuss prior deficience and other health and safety concerns. Licensee will be notified by mail of date and time.
8
9
10
11
12
13
14
This is evidence by:
Licensee could not provide a valid CPR card.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Ana Tolentino
LICENSING EVALUATOR NAME:Maryrose Breault
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022


LIC809 (FAS) - (06/04)
Page: 9 of 9