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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 163909597
Report Date: 01/09/2020
Date Signed: 01/10/2020 09:29:51 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:LOPEZ, ELVA FAMILY CHILD CAREFACILITY NUMBER:
163909597
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
01/09/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Elva LopezTIME COMPLETED:
12:30 PM
NARRATIVE
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On this date, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced annual/random inspection. LPA met with Licensee, Elva Lopez, who provided a tour of the home, inside and outside, as shown on the facility sketch. The swimming pool was fenced per regulation. There were no firearms in the facility. Poisons, cleaning compounds, medications and other hazardous items were inaccessible to children. There was no fireplace. The fire extinguishers, smoke detectors, and carbon monoxide indicator met Community Care Licensing (CCL) regulations. The home was kept clean and orderly, with heating and ventilation for safety and comfort. Stairs barricaded when children under the age of five years old are present. Safe toys and play equipment were observed. There were two birds, kept in a cage, inside the home. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. Licensee had a working telephone and the above telephone number was verified. Adequate supervision was being provided during this inspection. Outdoor play areas were fenced or supervised by the Licensee or care giver. Capacity as specified on the license was being maintained. Children’s records contained all emergency information specified by regulation. The Licensee and other personnel as specified completed training on preventative health practices including pediatric CPR and first aid; Expires: 6/30/2020. Licensee also provided proof of required immunization (Pertussis/Measles/Influenza) and/or written declaration declining flu shot, as well as, proof of required Mandated Reporter Training; Completed 3/9/19.

There were no excluded individuals present at this home. LPA verified Licensee and her husband had a criminal record clearance or exemption as indicated on LIS 531 – Facility Personnel Report Summary, however, Licensee's daughter turned 18 years old (see Confidential Names form (LIC 811) dated 1/9/2020) in October and has not been fingerprint cleared.

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SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2019
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: LOPEZ, ELVA FAMILY CHILD CARE
FACILITY NUMBER: 163909597
VISIT DATE: 01/09/2020
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. Licensee is aware that an IMS plan is required to be submitted to the Licensing office if they provide any of these services.

LPA discussed with Licensee information regarding the California Department of Social Services (CDSS) Provider Information Notices (PINs) communication system and information regarding Safe Sleep Regulations.

Business hours are Monday through Friday 6:30 AM to 5:30 PM and other hours as arranged.

Per Title 22 of the California Code of Regulations, the following deficiency was found: (see Facility Evaluation Report (cont) with deficiency information)

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

* Any Licensing reports indicating a Type A deficiency shall be posted immediately and for the next 30 days and copies provided of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Health & Safety Section 1596.859(a) shall be cited and a civil penalty of $100.00 for failure to provide copies to parents/guardians of children in care and newly enrolled children, and for failure to maintain written verification of receipt of licensing reports indicating a Type A violation (LIC 9224).

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: LOPEZ, ELVA FAMILY CHILD CARE
FACILITY NUMBER: 163909597
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/09/2020
Section Cited

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Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption. This requirement was not met as evidenced by Licenee's admitting her daughter turned 18 years of age in October and has not been fingerprinted. This poses an
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immediate risk to the health, safety, or personal rights of children in care.
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appointment. An immediate civil penalty of $500 was assessed at today's inspection due to an adult living in the home without a criminal record clearance.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Kathy PachecoTELEPHONE: (559) 341-5116
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2020
LIC809 (FAS) - (06/04)
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