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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019947
Report Date: 08/10/2023
Date Signed: 08/10/2023 04:14:22 PM


Document Has Been Signed on 08/10/2023 04:14 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 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: 8DATE:
08/10/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Miriam LopezTIME COMPLETED:
04:25 PM
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On 8/10/2023, Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced case management Licensee initiated inspection for the above facility. LPA met with Licensee, Miriam Lopez and LPA observed 8 children in care. LPA confirmed criminal clearance for all adults.

Licensee submitted an update on her application, outside facility sketch, photos and an outline for a newly installed pool and spa, as well as a mesh fence around the bodies of water. During this inspection LPA filled out “Bodies of Water Checklist”. According to the bodies of water Department regulations the family childcare home is appropriately fenced. According to Licensee the children will not have access to the pool during operating hours of Monday-Friday 8:00 am to 5:30 pm. The pool will be used for personal use and Licensee agrees that fencing will remain in place whenever licensed care is provided, and as long as the mesh fence makes the swimming pool inaccessible to children as determined by licensing staff. LPA took photos and video of the self-closing gate. The gate surrounds the swimming pool and spa, and the mesh fence is secure and in good condition as it was installed on July 26, 2023. The facility sketch was updated by the Licensee and LPA will place in the file.

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.

Exit interview was conducted, appeal rights given, and a copy of this report was reviewed with the licensee, Miriam Lopez.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023
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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