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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013414016
Report Date: 05/17/2023
Date Signed: 05/17/2023 05:10:26 PM


Document Has Been Signed on 05/17/2023 05:10 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:LOPEZ, ROSA & ALEGRIA, ADANFACILITY NUMBER:
013414016
ADMINISTRATOR:LOPEZ, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 261-2776
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:14CENSUS: 13DATE:
05/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Rosa LopezTIME COMPLETED:
05:20 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 5/17/2023 at 02:00 PM Licensing Program Analyst (LPA) Diana Campos conducted an unannounced Annual Required inspection at Rosa Lopez and Adan Alegria Family Childcare Home. LPA met with licensee Rosa Lopez and explained the purpose of today's inspection. LPA were granted the inspection authority to enter the Home. The family childcare home days and hours of operation are Monday to Friday 07:30 AM to 05:30 PM. Present in the home at time of inspection were licensee, her adult daughter who assists with day care and 13 children in care consisting of 3 infants, 6 preschoolers and 4 school age children.

Indoor Space: At 3:00 PM A health and safety tour of inside the home was done. LPA toured the premises with licensee. The home is sanitized and orderly in compliance with Title 22 Regulations at this time. There is a 3A40BC fire extinguisher, smoke and carbon monoxide detector in the home. The home is a one story house consisting of 4 bedrooms, 3 bathrooms, living room, dining room, eat-in kitchen, day care room and basement.


In use: are the living room, dining room, kitchen, 2 bedrooms on the left side, the child care room, the 2 rooms located next to the child care room, the bathroom in the child care room, and the bathroom in the backyard is used as the primary areas for day-care. All other areas of the home are off limit and are made inaccessible by barrier gates, closed and/or locked doors and visual supervision. Medicines, cleaning products, sharp objects are stored inaccessible to children during today's inspection. LPA reminded licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Licensee states that there are no pets and arms and ammunition stored in the home. The fireplace is blocked to prevent access by children in care, and the home maintains a working telephone.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: LOPEZ, ROSA & ALEGRIA, ADAN
FACILITY NUMBER: 013414016
VISIT DATE: 05/17/2023
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
Outdoor Space: AT 4:00 PM LPA toured the outdoor area (backyard) and observed it was fenced. LPA observed there are no pools, hot tubs or other bodies of water. There is a small room built over the back yard patio and provider understands that 100% visual supervision is required when used by day care children.

Children files and Facility files were reviewed. Facility contained Children's Roster, Licensee’s mandated reporter training expires 5/12/2025, pediatric CPR and first aid expires 5/4/2025.
Licensee was reminded that all adults 18 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.

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



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.

No deficiencies cited during today's inspection.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Rosa Lopez.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4