426216201-11-1-2022-17-CC-MBRT-CKRQGC-20221101120918

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216201
Report Date: 11/01/2022
Date Signed: 11/01/2022 12:09:41 PM

Document Has Been Signed on 11/01/2022 12:09 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 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:	11/01/2022
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	11:23 AM
MET WITH:	Leticia Lopez		TIME COMPLETED:	12:09 PM

NARRATIVE

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On November 1^st, 2022 at 11:23 AM, Licensing Program Manager (LPM) Ana Tolentino, and Licensing Program Analyst (LPA) Rosie Breault met with licensee, Leticia Lopez for an informal conference meeting at the Department of Social Services, Santa Barbara Regional Office. The purpose of the meeting was to discuss recent concerns with the operation of the family childcare home pursuant to Title 22, Division 12 of the California Code of Regulations.

Deficiencies and Concerns discussed:

Criminal Clearance - Civil Penalty
Potential Hazards within the Family Childcare Home
Reporting Requirements
Safety and First Aid Requirements
Safe Sleep
Safe Grounds
Repeat Violations

Licensee was reminded of all Title 22 Rules and Regulations applicable to above stated concerns and LPA provided the following resources:

Santa Barbara County Resources and Referrals (805) 925-6701
https://www.crrsbc.org/contact/

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

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: 11/01/2022

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SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

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: 11/01/2022

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Forms provided to Licensee:

Safe Sleep Frequently Asked Questions
Individual Infant Sleeping Plan
Emergency Disaster (Fire) Drill Log

The following was discussed, and the licensee has agreed to the following from today’s informal conference.

Licensee shall submit a written statement indicating how she will maintain compliance with California Code of Regulations, Title 22, Division 12 at all times by 11/15/2022
Licensee will submit a written statement on how she has resolved recent deficiencies cited on 10/11/2022 by 11/15/2022.
Licensee shall be placed on a 2-year compliance plan.
Licensee shall be recommended for the Technical Support Program (TSP) for training, education, and support.

Compliance plan effective today, 11/1/2022. Increased unannounced visits to the family childcare home will be made for the next two years to monitor compliance.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

LIC809 (FAS) - (06/04)

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