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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407708
Report Date: 02/20/2020
Date Signed: 02/20/2020 11:03:25 AM

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, GUADALUPEFACILITY NUMBER:
073407708
ADMINISTRATOR:LOPEZ, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 516-7645
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:14CENSUS: 2DATE:
02/20/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:01 AM
MET WITH:LOPEZ, GUADALUPETIME COMPLETED:
11:15 AM
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At 08:01 AM Licensing Program Analyst (LPA) LaKeisha Chew conducted an unannounced ANNUAL REQUIRED inspection. Present during today’s inspection was the licensee, her fingerprint cleared husband, fingerprint cleared son, and two children in care (one preschool-age and infant). The licensee is operating within the licensed capacity. Licensee has a dual licensee for foster care and childcare. Licensee guided LPA a tour of home for Health and Safety inspection. Home met regulations for safety and comfort.

This is a two story 5 bed, 4 bathroom home. On limits area consist of the living room, kitchen, family room, first floor bathroom and fenced backyard. The remainder of the home is off limits. There are no bodies of water at this home. There are no firearms on the premises as stated by the licensee.

Detergents and cleaning compounds are stored in the laundry room and inaccessible to children.
Stairs are gated. The fireplace located in the family room is securely barricaded to prevent access by children. LPA verified that the 2A10BC fire extinguisher is fully charged. The home is equipped with both a smoke detector and carbon monoxide detector. There is a working land line telephone in the home. 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 and found to be complete.

The licensee has required immunization's.Licensee was encouraged to email ChildCareAdvocatesProgram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

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 JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Lakeisha ChewTELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
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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