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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408734
Report Date: 10/30/2023
Date Signed: 10/30/2023 12:35:26 PM


Document Has Been Signed on 10/30/2023 12:35 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:HERNANDEZ LOPEZ, SANDRAFACILITY NUMBER:
073408734
ADMINISTRATOR:SANDRA HERNANDEZ LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 205-6312
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY:14CENSUS: 5DATE:
10/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Sandra Hernandez LopezTIME COMPLETED:
12:41 PM
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On October 30, 2023 at 9:40am Licensing Program Analyst (LPA) Indira Loza met with Licensee Sandra Hernandez Lopez for the purpose of conducting an unannounced 1-year annual inspection. Present during today's inspection were the Licensee, Assistant Maria Muro, and 5 preschool-age children. Operating days and times are Monday - Friday 24 hours.

The home is single family house consisting of three bedrooms, one bathroom, living room, dining area, kitchen, fully fenced front yard, a walkway on both sides of the house, fully fenced backyard with two storage sheds, and a garage.

On Limit Areas - front yard, walk-way on the left of the house, backyard, living room, dining area, bedroom across from the kitchen, and bathroom.
Off Limit Areas - garage, walkway to the left of the house, two bedrooms one (across from the bathroom and one to the left of the bathroom), kitchen, two storage sheds in the backyard.
ISOLATION AREA - either the nap room or the living room depending on what activities are taking place

The home has a fully charged 2A10BC fire extinguisher, a working combined smoke/carbon monoxide detector in the living room, and a working telephone. Licensee does not have Liability Insurance and all files reviewed had the "Affidavit Regarding Liability Insurance for Family Childcare Home" (LIC 282). Per the Licensee there are no firearms in the home. The Licensee has a current CPR/First Aid certificate which expires on January 1, 2024; and a current Mandated Reporter Certificate which expires on May 2024. The Licensee's assistants also had a current CPR certificate and Mandated Reporter Certificate. The home has heating and ventilation for safety and comfort. LPA observed the backyard to be clean with age-appropriate toys and learning materials, as well as inside the home. Toxins, medicines, and hazardous items were inaccessible during today's inspection. The Licensee provides breakfast, lunch, dinner, and snacks. LPA provided the Licensee with the Infant Safe Sleep Regulations. There were no bodies of water on the premises of the daycare.
**********************************Report Continues on LIC 809-C*******************************
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2023
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: HERNANDEZ LOPEZ, SANDRA
FACILITY NUMBER: 073408734
VISIT DATE: 10/30/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02. When any IMS is 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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed in Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During the Exit Interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.



There were no deficiencies cited during today's visit.
Exit interview conducted and report was reviewed with Licensee Sandra Hernandez Lopez.
Report and Appeal Rights were provided.
A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023
LIC809 (FAS) - (06/04)
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