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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020309
Report Date: 12/13/2019
Date Signed: 12/13/2019 02:10:13 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:
198020309
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
12/13/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Adriana Lopez_LicenseeTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Reiko Jones-Modeste conducted an unannounced inspection to increase capacity at the facility listed above. LPA met with Licensee Adriana Lopez who guided analyst on a tour of the facility. LPA observed two infants in care(Includes Licensee's infant daughter) and one cleared adult Licensee husband Miguel Casillas. Per the Licensee two adults currently reside in the home. Licensee stated operating hours will be Monday-Friday, 6am-6pm. Care will be provided for children ages 0-12 years old. The Fire Department has granted clearance for a maximum capacity of 14 children, fire clearance received on 11/27/19.

All areas identified on the facility sketch were inspected. This is a one-story home that includes three bedrooms, three restrooms, kitchen, family/living room, front yard and backyard (fenced). The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, as well as any hazardous items that may pose a danger to children.

Off limits/inaccessible to daycare children: All bedrooms, two restrooms, kitchen and backyard. These areas are made inaccessible with child safety knobs on the bedroom doors and a child safety gate.
Accessible to daycare children: living room, one restroom and front yard.

Upon receipt the Licensee shall post the Notice of Site Visit. This report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

At this time, the Licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today. LPA will recommend the increase in capacity as the Licensee meets requirements for an increase and the fire clearance was received and granted for 14 children.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 981-3385
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019
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: 198020309
VISIT DATE: 12/13/2019
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LPA observed Licensee and Licensee husbands required vaccinations.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov

Per Licensee, there are no other licenses held at this location. Licensee recently changed locations as she was licensed at another address for five years.

Once licensed, the applicant is required to adhere to the terms and limitations as stated on the license.



Exit interview was conducted with the Licensee, who is in agreement with the above. A copy of this report and all other licensing reports will be made available to the public for three years.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 981-3385
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019
LIC809 (FAS) - (06/04)
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