198014231-3-22-2024-33-CC-SLII-D3LTFP-20240322144153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198014231
Report Date: 03/22/2024
Date Signed: 03/22/2024 02:42:03 PM

Document Has Been Signed on 03/22/2024 02:42 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	LOPEZ FAMILY CHILD CARE		FACILITY NUMBER:	198014231
ADMINISTRATOR:	LOPEZ, XIOMARA & JULIO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 620-1873
CITY:	POMONA	STATE: CA	ZIP CODE:	91766
CAPACITY:	14	CENSUS: 5	DATE:	03/22/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Licensee Xiomara Lopez		TIME COMPLETED:	03:15 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 3/22/24 at 1:00pm, Licensing Program Analysts (LPA) Stephanie Li conducted an unannounced required 3 year inspection to the above facility. A risk assessment was conducted upon entry. LPA met with Licensee Julio Lopez and Xiomara Lopez, daughter Nicole Lopez guided analyst on a tour of the facility because licensee’s went to pick up children getting out of school. Nicole helped to translate. Home is located down a long driveway off San Antonio Ave. There were 0 children and 3 adult present upon arrival but 5 children arrived during visit. Per Licensee, there is currently 8 child enrolled. A current children’s roster was available for review. This is a one story home which consists of 3 bedrooms, 2 restrooms, living room, dining room, kitchen, back yard, garage and side yard (fenced). The children have access to child care room, back patio, side yard, living room, dining room, kitchen and the restroom located through the hallway. The licensee states that 2 adults and 0 children currently live in the home. Per Licensee there are no firearms or weapons stored in the home. No bodies of water was observed. Per licensee, areas off limits to children and parents include 2 bedrooms, 1 restroom, right side back yard, and garage. LPA toured all areas used by children during this visit. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection. Cleaning compounds, and medications were observed to be inaccessible to children. Per licensee, there are no poisons kept in the home. The restroom that children use was observed to be safe and sanitary. There is telephone service via cellphone and landline that stays at the facility during operation hours. The home is observed to be clean and orderly with central air and heat. There are toys available for children. Napping crib and cots were observed in the child care room. Page 1 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie Li	TELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

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 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 198014231
	VISIT DATE: 03/22/2024

NARRATIVE

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At 1:20pm, LPA observed the required 2A 10BC fire extinguisher with purchase receipt dated 5/2023 available for review. LPA advised licensee that per State Fire Marshall standards that fire extinguishers shall be serviced annually and if self purchasing to keep the receipt with the fire extinguisher. Smoke and carbon monoxide detectors were tested and are operable. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill was conducted in 2/24/24. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted on the parent board in the classroom.

Currently, children are using the side yard and back patio for outdoor play time. The outdoor play area was observed to be fenced. LPA observed the outdoor yard to have appropriate toys and other materials for children to use. LPA did not observe any objects that can pose a danger to children in the outdoor yard. The licensee is observed to be operating within the license capacity limitations.

At 1:45 pm, children and adult records were reviewed, including emergency information and were observed to be complete. The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee Pediatric First Aid and CPR expired on 2/24/25 . There are first aid supplies available. Licensee has completed the Mandated Reporter AB 1207 Training Certificate expiration date 3/10/24. LPA shared that mandated reporter is available in Spanish now. Licensee’s daughter will help her get it completed. LPA advised licensee that mandated reporter training is required to be renewed every two years.

Licensee stated IMS is being provided for grand daughter in care. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, 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: https://www.ada.gov/resources/child-care-centers/.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie Li	TELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 198014231
	VISIT DATE: 03/22/2024

NARRATIVE

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Licensee understands that IMS plan needs to be submitted to the department. Daughter Nicole Lopez stated she will assist her mother in turning the IMS plan in. Licensee will submit via email to LPA by 4/5/24.

LPA discussed the safe sleep regulations and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/safe-sleep as an additional resource. LPA also informed applicant/licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Safe sleep brochure provided for review.

Licensee informed LPA of grand daughters, Poppy Katakias’ medical condition. Grand daughter was born premature and takes medication and needs to sleep propped up at a slant. LPA observed that the mattress setting is slanted within the crib, no bumper, pillow, wedges, or sleepers or used in the crib. LPA discussed process for exemption for grand daughter for medical condition.

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 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.

Megan’s Law - Family Child Care Homes During the exit interview, the Licensee Maria Tovar, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie Li	TELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 198014231
	VISIT DATE: 03/22/2024

NARRATIVE

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MyChildCarePlan.org – Centers and Family Child Care Homes Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Xiomara Lopez.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie Li	TELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

LIC809 (FAS) - (06/04)

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