198016771-5-5-2022-54-CC-AMOY-CE5UTE-20220505155149

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016771
Report Date: 05/05/2022
Date Signed: 05/05/2022 03:52:04 PM

Document Has Been Signed on 05/05/2022 03:52 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	LOPEZ FAMILY CHILD CARE		FACILITY NUMBER:	198016771
ADMINISTRATOR:	LOPEZ, NANCY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 331-4978
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90059
CAPACITY:	14	CENSUS: 7	DATE:	05/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Nancy Lopez, Licensee		TIME COMPLETED:	04:00 PM

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Inspection conducted in Spanish

Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Required 1 year inspection to the above facility. Upon arrival LPA met with Nancy Lopez, Licensee. LPA explained the purpose of the inspection and provided Entrance Checklist, LIC 126. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. There were 7 children present (including 1 infant). Also present was Maria Servellon, assistant and a volunteer, Adult #1 who was not background cleared, per licensee, Adult #1 was present only to assist Child #1 during field trip. LPA discussed conditions of individuals who are exempt from the requirement to submit fingerprints according to Title 22 Regulation section 102370.

Per licensee the hours of operation are Monday-Friday 7:00am-5:00pm. Individuals residing in the home were discussed and noted.

Licensee is currently participating in the Early Headstart program.

This is a single story home with 4 bedroom/1 bathroom, living room, dining room and kitchen. There is also a fenced front yard and fenced backyard.

Areas accessible to children are: The bathroom, located in the hallway, living room and dining room, 1 bedroom and daycare room. LPA observed children napping in the daycare room and living room.

Areas off limits include: Master bedroom, 1 bedroom, front yard, storage shed located in the backyard. The bedrooms are made inaccessible with child-proof door knobs. The door to the storage shed is maintained locked. Cleaning supplies, detergents and other toxic items are maintained locked with safety locks in the kitchen and bathroom cabinets. Knives and sharp objects are kept in locked kitchen drawer. Licensee provides meals to children in care.

The licensee has a dedicated cellphone at the facility during operation hours.
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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 198016771
	VISIT DATE: 05/05/2022

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LPA observed Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. A current LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan. LPA provided an updated Pub 394 with current Regional Office information.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced 7/1/21, Licensee was reminded that fire extinguisher needs to be serviced yearly.

The home is observed to be clean and orderly. There are toys and other age appropriate material available for children.
Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home. Licensee has 2 dogs, 1 large dog and 1 small, which are kept away from children care in dog run.

The bathroom that children use is located in the observed to be clean and free of hazards.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. There are individual cubbies for children to place their belongings. There is a play structure that is age appropriate with grass for cushion. LPA did not observe any objects that could be hazardous to children in care.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months)

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm --------Page 2 – Report Continues

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

LIC809 (FAS) - (06/04)

Page: 2 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 198016771
	VISIT DATE: 05/05/2022

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LPA observed that licensee is implementing COVID-19 precautions: Adults were observed to wear masks, frequent hand washing, cleaning frequently touched areas at least 2 times per day.
The licensee was reminded to never leave children in the car unattended, always buckle children in car seat when being transported.

Infant Care: Licensee states the following a sleep supervision plan for infants: Licensee or assistant stay in the same room as infant for the duration of the nap and document 15 minute checks. LPA observed a sleep log for infant in care.
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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

There are no deficiencies cited as a result of this inspection.

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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Nancy Lopez

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

LIC809 (FAS) - (06/04)

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