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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019948
Report Date: 04/21/2020
Date Signed: 04/21/2020 04:28:40 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:
198019948
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
04/21/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Maura Lopez, LicenseeTIME COMPLETED:
04:30 PM
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At 3:15pm Licensing Program Analyst (LPA) Alanna Gontarek conducted an unannounced case management initiated tele-inspection to the above facility. This was a tele-inspection due to COVID-19 pandemic. LPA met with Maura Lopez, Licensee, who guided analyst on a tour of the facility. The purpose of this inspection is due to licensee’s request for a capacity increase on 01/14/2020. Currently, the licensee’s capacity is eight. Licensee wishes to increase to a capacity of fourteen. Per Licensee, family members residing in the home are 2 adults and 0 children. All individuals present in the home have obtained a criminal record clearance or exemption prior to working. Per licensee, operation hours will be Monday to Sunday 5:30AM to 11:59PM. There were 4 children present upon arrival.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one story home which consists of 4 bedrooms, 2 bathrooms, kitchen, living room, two daycare rooms, garage, front yard, and backyard (fenced).

Per Licensee, off-limit areas include: kitchen, garage, two bedrooms, one bathroom in master bedroom, and the front yard. The daycare areas include: the living room, two day care rooms, one bathroom in hallway and backyard. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation (AC unit installed in wall of front side of house) and heating (barricaded wall heater). Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. LPA observed medicines and knives to be stored in a locked upper cabinet located in the kitchen. LPA observed the detergents to be stored in the locked garage. LPA observed the cleaning compounds to be stored under the sink in a locked cabinet The Licensee states that there are no poisons at the facility. The Licensee was advised that any poisons must be locked with a key or combination lock. The valve on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag with last service date of 10/2019. Per State Fire Marshall standards, fire extinguishers shall be serviced **Page 1 of 2*
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-8417
LICENSING EVALUATOR NAME: Alanna GontarekTELEPHONE: (323) 854-8644
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020
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 2
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: 198019948
VISIT DATE: 04/21/2020
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annually. Smoke and carbon monoxide detectors were tested and are operable. Fire/disaster drill log was available for review and last date of conducted fire drill was 3/06/2020 and Earthquake Disaster Drill was conducted 3/13/2020. There is First Aid supplies available and located in backyard, along with a trash can of Earthquake preparedness supplies. Licensee's CPR/First Aid is current and expires on 3/23/21.

This facility currently does not have any children on medication.

Health and Safety Code 1596.7996 Effective January 1, 2019, CCC's and FCCH's are required to provide parents and guardians of children enrolled, enrolling or reenrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations and options for locations of affordable blood lead tests. 2019 Lead flyer Provided. LPA emailed Licensee Lead Flyer to hand out to parents.



Licensee is seeking to provide care for 14 children ages Birth to 12 years old. A fire clearance has been granted as of 4/15/2020.

Increase may/will be granted depending on LPM (Licensing Program Manager) approval.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

At 4:15 p.m., exit interview was conducted with Maura Lopez, Licensee, including, but not limited to Provider Rights, Appeal Procedures and Agency's Consultative Role.

**Page 2 of 2**

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-8417
LICENSING EVALUATOR NAME: Alanna GontarekTELEPHONE: (323) 854-8644
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020
LIC809 (FAS) - (06/04)
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