197494193-7-13-2021-30-CC-ARAZ-C4W26F-20210713170705

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494193
Report Date: 07/13/2021
Date Signed: 07/13/2021 05:07:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	LOPEZ FAMILY CHILD CARE		FACILITY NUMBER:	197494193
ADMINISTRATOR:	LOPEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 585-8318
CITY:	TARZANA	STATE: CA	ZIP CODE:	91335
CAPACITY:	14	CENSUS: 3	DATE:	07/13/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:22 AM
MET WITH:	Maria Lopez		TIME COMPLETED:	12:25 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 7/13/2021 at 11:30 AM Licensing Program Analyst (LPA) Angelica Ramirez, conducted an unannounced Annual Required Inspection and was met by Licensee, Maria Lopez. Prior to entering the home, LPA Ramirez confirmed with licensee that no one in the home has experienced any COVID-19 symptoms within the last 14 days. LPA also informed licensee that LPA has not experienced any symptoms within the same time frame.
Licensee is Spanish Speaking. Days and hours of operation are Monday through Friday from 6 AM to 6 PM. Three day care children were present during this inspection.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the living room, dining room, day care room and bathroom (located within day care room), and backyard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of a gate and child proof door knob (three bedrooms, one bathroom, and kitchen). There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (818) 585-8318.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Angelica Ramirez	TELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

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 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 197494193
	VISIT DATE: 07/13/2021

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

There are currently no infants in care.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training expired on 2/2021. LPA requested that licensee renew her Mandated Reporter Certificate and provide a copy to LPA by 7/19/2021. Licensee’s pediatric CPR/First Aid expires on 4/2/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are / are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Angelica Ramirez	TELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 197494193
	VISIT DATE: 07/13/2021

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

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. A copy of this report and LIC 9213 Notice of Site Visit will be provided to the licensee and the LIC9213 is required to be posted for 30 days.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Angelica Ramirez	TELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3