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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018211
Report Date: 01/15/2020
Date Signed: 01/15/2020 12:57:07 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:
01/15/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Licensee Leslie Lopez TIME COMPLETED:
01:05 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Roxana Lopez and Mireya Garcia conducted an unannounced annual random inspection to the above facility. LPA met with Leslie Lopez Licensee who guided analyst on a tour of the facility. Also present during this inspection, was Christina Lopez, Licensee’s Assistant and one child. Per Licensee, there are seven children that are currently enrolled. A current children’s roster was available for review. There was one child present upon arrival.

This is a two -story home which consists of 4 bedrooms, 2 bathrooms, kitchen, dining room, living room, play room, day care room, front yard and backyard (fenced). The children use the bathroom in the day care room, living room, play room, day care room, dining room and back yard areas. LPA observed that there is an electric fireplace in the living room. Per Licensee, areas off limits to children and parents include: upstairs, both bedrooms located downstairs and the restroom in the hallway. The licensee provides food for children in care.

The licensee states that 2 adults and 2 children currently live in the home. Per Licensee, she currently has one assistant, which is her daughter Christina Lopez. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms stored in the home.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a landline that is used at the facility during operation hours. There is ventilation and heating (central). The following was observed and reviewed during this inspection.
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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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
VISIT DATE: 01/15/2020
NARRATIVE
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Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. Poisons are locked in a cabinet in the laundry room and it is stored in a high cabinet. The restroom that children use was observed to be safe and sanitary.

Fireplaces are inaccessible to children. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 04/23/2019, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

The home is observed to be clean and orderly. Where children less than five years old are in care, stairs are fenced or barricaded. There is a child safety gate which keeps stairs inaccessible to children. There are toys available for children. Appropriate sleeping arrangements were observed.

Currently, children are using the back yard for outdoor play time. 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. LPA did not observe any objects that can pose a danger to children on the outdoor yard.

The licensee is observed to be operating within the license capacity limitations.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 10/26/2020. The assistant's Pediatric First Aid and CPR expires on 7/1/2021. There are first aid supplies available.

Children’s records were reviewed, including emergency information.

LPA observed that the licensee assistant does not have proof of immunization against influenza, pertussis, and measles. Licensee is missing proof of the influenza shot or declination.

The Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.

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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
LIC809 (FAS) - (06/04)
Page: 2 of 5
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
VISIT DATE: 01/15/2020
NARRATIVE
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LPA issued the Children's Records Review (LIC 857) and the Review of Staff Records (LIC 859) to the licensee during this inspection. The LIC 857 and the LIC 859 documents the children's files and the staff files that were reviewed.

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 documented was conducted on 10/09/2019.

There are 4 pets on the premises. Licensee has 1 dog, 2 cats and 1 fish and they are in the off limits bedrooms during operating hours.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Licensee states that she is currently caring for infants. LPA advised the licensee to sleep infants where they can always be directly supervised and advised the licensee against sleeping infants in a separate room. Licensee states that infants sleep in the day care room where they are constantly supervised.

LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA also consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, and Safe Sleeping practices.

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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
LIC809 (FAS) - (06/04)
Page: 3 of 5
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
VISIT DATE: 01/15/2020
NARRATIVE
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Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

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

Capacity Handout (Small & Large) was provided during this inspection.

Based on the LPA’s observations and records review, the following deficiency listed on the attached LIC 809 (deficiency page) is being cited in accordance with California Code of Regulations Title 22. Deficiency that is being cited need to be cleared to protect the children’s health & safety.

Exit Interview was conducted with Licensee Leslie Lopez

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 01/15/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/29/2020
Section Cited

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1597.622 (a)(1)- Employees or volunteers at family day care home; immunization requirements; records; exemptions. Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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This requirement has not been met as evidenced by LPA's staff records reviewed which shows that S2 does not have proof of immunizations. This poses a potential risk for the health and safety of the 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) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/15/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/15/2020
LIC809 (FAS) - (06/04)
Page: 5 of 5