198019947-11-5-2019-33-CC-BBEL-BHMS3C-20191105123055

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019947
Report Date: 11/05/2019
Date Signed: 11/05/2019 12:31:06 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 CARE		FACILITY NUMBER:	198019947
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	11/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Licensee Miriam Lopez		TIME COMPLETED:	12:30 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	An unannounced Annual/Random (Case Management-Licensee-initiated) inspection was conducted on this date by Licensing Program Analyst (LPA) B. Emiko Bell. The purpose of the inspection is because Licensee is requesting an increase in capacity from a small (capacity 8) to a large (capacity 14) and because the Department is now conducting annual inspections. Licensee qualifies because she has been licensed at this residence since 08/24/18. Upon arrival, LPA was greeted and let into the residence by licensee, to whom the reason for the inspection was announced. Census: Staff-child ratio was met. Licensee's days and hours of operation are Monday-Friday, 08:00 A.M. to 06:00 P.M. This is a single-story, single family residence with three bedrooms and one bathroom. All areas identified on the facility sketches were inspected in the following order: (indoors): Room 3, the restroom, the kitchen, the living room, Room 2, Room 1, and then (outdoors): the backyard and the converted garage. There are no areas designated as off-limits. Physical Plant: The residence was inspected for safety, comfort, cleanliness, telephone service (licensee has a cell phone and a landline), heating and ventilation ( there is a ceiling fan in each bedroom, there is central heating and air-conditioning, and there is a wall air-conditioner in the garage), inaccessibility to poisons, detergents, cleaning compounds (kept under the kitchen sink which has a childproof latch,) medicine (which is kept on a shelf in the cabinet in the hallway and which is latched with an eye and hook latch) and hazardous items that can pose a danger to children.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2019

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: 198019947
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/05/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/15/2019 Section Cited	1 2 3 4 5 6 7	OPERATION OF A FAMILY CHILD CARE HOME The home shall be free from defects or conditions which might endanger a child. -This requirement is not met as evidenced by: LPA observed that there were two aloe vera plants which were accessible to the children
	8 9 10 11 12 13 14	in the backyard. This poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
Type B 11/15/2019 Section Cited	1 2 3 4 5 6 7	OPERATION OF A FAMILY CHILD CARE HOME Each family child care home shall conduct fire drills and disaster drills at least once every The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
	8 9 10 11 12 13 14	-This requirement is not met as evidenced by: LPA observed that LIcensee's fire drill log documents the date the drill was ran but not the time. This poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14

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: Claudia Guangorena	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2019

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: 198019947
	VISIT DATE: 11/05/2019

NARRATIVE

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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
There is one First Aid Kit, which is mounted above the fire extinguisher in the hallway closet.

Backyard: The backyard is fenced on all three sides by a chain-link fence. LPA observed two aloe vera plants which are accessible to the children.

Garage: Licensee stated that children only do activities in the converted garage; they do not eat or nap in the garage.

Paperwork: Licensee's roster was current and complete. Pediatric First Aid/CPR were issued by the American Heart Association and expire 04/20. Licensee completed the Mandated Reporter Training on 09/06/19. Licensee provided verification of MMR and TDAP immunizations and influenza declination. Both licensee and her assistant's files were checked and are complete.

As there are six children enrolled; five files were reviewed for the required forms. All files were checked for all forms as listed on LIC 311D and all are complete. (See LIC 811 for details.)

Prior to the capacity increase being granted, Licensee will need to provide verification that the citations which have been issued have been corrected. See 809D for documentation of deficiencies.

**************During today's visit, the Confidential Names list was provided to the Licensee.***************

The Notice of Site Visit was posted by Licensee in LPA's presence. The Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in the issuance of a citation and the assessment of a $100 civil penalty.

An exit interview has been conducted with and a copy of this report has been signed by and provided to Licensee Miriam Lopez.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2019

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: 198019947
	VISIT DATE: 11/05/2019

NARRATIVE

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Toys and napping equipment: There are age-appropriate toys and napping equipment on the premises. Licensee has two playpens and five mattresses. The children nap in room 2 and the living room. In addition, licensee has three couches that the daycare children can sleep on.

Parent Board: The Parent Board is posted on the wall to the left of the entryway of the garage. All required postings were observed (the license, the Notification of Parents Rights, the Emergency Disaster Plan and the Child Passenger Safety Law).

Pets: Licensee has one dog, a Labrador. Licensee states that she has her vaccination records on file and that they are current.

Fire safety: Licensee has two fire extinguishers, size 3-A:40-B:C. One is mounted on a wall in the garage and one is mounted in the kitchen on the wall. They were last serviced 08/12/19. Licensee keeps a fire drill
log posted on the Parent Board in the garage. LPA observed that the last fire drill was logged on 08/06/19 but no time was noted. There are five smoke detectors on the premises; all were tested and only the one in room 3 was not operable. There is one in each bedroom, the kitchen and the garage. There is a carbon monoxide detector mounted on the wall in the kitchen; it was also tested and is operable. There is a screen in front of the fireplace in the living room.

Transportation: Licensee stated that she rarely transports daycare children but permitted her vehicles to be inspected. She has one seven passenger van and one four passenger car. She has two booster seats and one car seat.

Firearms: Licensee stated that there are no weapons or firearms on the premises.

Incidental Medical Services: This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2019

LIC809 (FAS) - (06/04)

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