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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018211
Report Date: 10/28/2019
Date Signed: 10/28/2019 05:22:01 PM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
198018211
ADMINISTRATOR:LOPEZ, LESLIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 235-3793
CITY:SOUTH EL MONTESTATE: CAZIP CODE:
91733
CAPACITY:14CENSUS: 1DATE:
10/28/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:01 PM
MET WITH:Leslie Lopez, LicenseeTIME COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) M. Garcia and A. Gontarek conducted a Case Management Deficiencies Inspection to address deficiencies observed.

I. During a walk-through of the facility, LPAs observed that there was one infant napping inside the playroom on a car seat with a blanket covering the car seat and child (Picture was taken).

LPAs provided the licensee with a copy of the English and Spanish PIN 19-02-CCP: Child Care Provider’s Guide to Safe Sleep awareness campaign to prevent infant sleep related fatalities.

The following deficiency is being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. Please refer to LIC809D for documentation of deficiency cited.

A copy of this report must be provided to the authorized representatives of all currently enrolled children and must also be provided to newly enrolled children for the next 12 months. The report shall be provided no later than the next business day or the next day the child is in care. The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: www.ccld.ca.gov.

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in a visible location for the authorized representatives of children.

Exit interview conducted with Licensee Leslie Lopez. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights. Page 1 of 1
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2019
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198018211
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/28/2019
Section Cited

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102423-Personal Rights:(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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This requirement is not met as evidenced by LPAs observing that there was one infant napping inside the playroom on a car seat with a blanket covering the car seat and child. This poses an immediate health and safety risk to children in care.
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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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2019
LIC809 (FAS) - (06/04)
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