<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019947
Report Date: 08/23/2021
Date Signed: 08/23/2021 04:11:04 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:
198019947
ADMINISTRATOR:MIRIAM LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 254-8023
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:14CENSUS: 6DATE:
08/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Licensee Miriam LopezTIME COMPLETED:
04:00 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/Required-1 year inspection was conducted on this date by Licensing Program Analyst (LPA) B. Emiko Bell.

The purpose of the inspection is because the Department is now conducting annual inspections and because Licensee notified LPA that she bought an above-ground pool in early August.

Upon arrival, LPA was greeted and let into the residence by Licensee, to whom the reason for the inspection was announced.

At 10:35 am, licensee guided LPA to the converted garage to take census. There were two staff with three children: one infant and two 3 year olds. At 12:20 pm, census was taken again when three school-aged children arrived, ages 4,4 and 5. Staff-child ratio was met.

Licensee's days and hours of operation are Monday-Friday, 05:00 am to 06:00 pm. 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: (outdoors): the converted garage, the backyard, and (indoors): the bathroom, the kitchen, the living room, Room 3 and Room 2. Room 1 was not inspected as it was locked.

There are no areas designated as off-limits.

Physical Plant: The residence was inspected for safety, comfort, cleanliness, telephone service (licensee only has a cell phone), 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
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
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 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: 198019947
VISIT DATE: 08/23/2021
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
26
27
28
29
30
31
32
 Page 2/3

hazardous items that can pose a danger to children.

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 03/05/21. Licensee keeps a fire drill
log posted on the Parent Board in the garage. LPA observed that the last fire drill was logged in July 2021 but no date was noted. There are five smoke detectors on the premises; three of the five were tested (not the ones in room 3 nor in room 1) and all three were 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. The fireplace in the living room was taken down

Transportation: Licensee transports daycare children to and from school only. She has one seven passenger van and an eight passenger SUV. 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 GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
LIC809 (FAS) - (06/04)
Page: 5 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: 198019947
VISIT DATE: 08/23/2021
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
26
27
28
29
30
31
32
 Page 3/3

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. Since the last inspection, licensee has installed artificial turf on part of the backyard as cushioning material and has had a pergola constructed. The above ground pool is fenced by a mesh fence and is located next to the pergola area (see 812 for details.) Licensee demonstrated and LPA observed that the gate does not swing away from the pool.

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

LPA began reviewing licensee's paperwork at 02:30-03:30. As there are 13 children enrolled; five files were reviewed for the required forms. Of the five children's files checked, one was of an infant; the file did not contain documentation of a 15-minute check.

Please see 809D for documentation of deficiencies. During today's visit, the Confidential Names list was provided to the Licensee.

Upon receipt, the Licensee shall post the Notice of Site Visit and the “D” page of the Licensing report. Both the Notice of Site Visit and the “D” page shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100 civil penalty. A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next 12 months. The LIC 9224 Acknowledgement of Receipt of Licensing Reports must be maintained in each child's file immediately upon receipt from the parent. LPA provided Licensee with a blank copy of the LIC 9224 Acknowledgement of Receipt of Licensing Report.

An exit interview has been conducted with and a copy of this report has been signed by and provided to Licensee Miriam Lopez. Appeal Rights have been provided and explained to Licensee Lopez as well.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
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: 198019947
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/02/2021
Section Cited

1
2
3
4
5
6
7
INFANT SAFE SLEEP
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Date, infant's name, time of each 15-minute check.
8
9
10
11
12
13
14
-This requirement is not met as evidenced by: Of the five children's files checked, one was of an infant; the file did not contain documentation of a 15-minute check.*This poses a potential risk to the health, safety or personal rights of children in care.*
8
9
10
11
12
13
14

1
2
3
4
5
6
7
8
9
10
11
12
13
14
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 GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2021
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: 198019947
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/24/2021
Section Cited

1
2
3
4
5
6
7
OPERATION OF A FAMILY CHILD CARE HOME
Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code. In addition to meeting all of the aforementioned requirements for fences, gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use.
8
9
10
11
12
13
14
-This requirement is not met as evidenced by: The pool gate swings inward towards the pool..*This poses an immediate risk to the health, safety or personal rights of children in care.*
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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 GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5