073407708-7-16-2019-02-CC-CACA-BE5QFD-20190716120746

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407708
Report Date: 07/16/2019
Date Signed: 07/16/2019 12:07:51 PM

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, GUADALUPE		FACILITY NUMBER:	073407708
ADMINISTRATOR:	LOPEZ, GUADALUPE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 516-7645
CITY:	OAKLEY	STATE: CA	ZIP CODE:	94561
CAPACITY:	14	CENSUS: 3	DATE:	07/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Guadalup Lopez		TIME COMPLETED:	12:20 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	Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced ANNUAL/RANDOM inspection. Present during today’s inspection was the licensee, her fingerprint cleared husband, fingerprint cleared son, one preschool aged child and two school aged children in care. Licensee is also licensed for foster care. The home was toured for Health and Safety Inspection. On limits area consist of the living room, kitchen, family room, first floor bathroom and backyard. The remainder of the home is off limits. There are no pools, spas, hot tubs, or any other similar bodies of water at this home. There are no firearms on the premises as stated by the licensee. Detergents and cleaning compounds are stored and inaccessible to children. Stairs are gated. The fireplace is barricaded to prevent access by children. LPA verified that the fire extinguisher is fully charged. The home is equipped with both a smoke detector and carbon monoxide detector. There is a working telephone in the home. Outdoor play area is fenced. The licensee was reminded that children are not to be left in parked vehicles. The licensee is operating within the licensed capacity. LPA did not observe any child left without supervision during the inspection. Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children or an immediate civil penalty can be assessed. Children files were reviewed. Files reviewed contain children’s emergency information. The licensee has required immunizations.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LOPEZ, GUADALUPE	FACILITY NUMBER: 073407708
	VISIT DATE: 07/16/2019

NARRATIVE

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Incidental Medical Services (IMS) was discussed. The following information regarding ADA was provided to licensee. US DOJ toll free ADA Information Line (800)514-0301 FAQ and ADA http://www.ada.gov/childqanda.htm LPA discussed the requirement to create a plan of operation when needed. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417.

Licensee was encouraged to email ChildCareAdvocatesProgram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

Safe sleep practices were discussed with the licensee.

There are no deficiencies cited during today’s inspection.

Exit interview was conducted with Guadalupe Lopez.

Licensee was provided a copy of the appeal rights.

Notice of Site visit was provided at the time of inspection and must be posted for 30 days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

LIC809 (FAS) - (06/04)

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