198020309-7-2-2021-54-CC-JESA-C4JRTW-20210702131903

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020309
Report Date: 07/02/2021
Date Signed: 07/02/2021 01:19:12 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	LOPEZ FAMILY CHILD CARE		FACILITY NUMBER:	198020309
ADMINISTRATOR:	ADRIANA LOPEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 604-9664
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90023
CAPACITY:	14	CENSUS: 4	DATE:	07/02/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:44 AM
MET WITH:	Licensee, Adriana Lopez		TIME COMPLETED:	01:45 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	On 7/2/21 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced annual inspection to the above facility. LPA arrived at the facility at 10:44AM and met with Adriana Lopez, Licensee who guided analyst on a tour of the facility. Per Licensee, there are 10 children that are currently enrolled but at the moment 5 children are on vacation. A current children’s roster was available for review. There were 4 children present upon arrival. Individuals who reside in the home were noted and discussed. Per Licensee, they are currently hiring one assistant. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed childcare home. Licensee states that there are no firearms stored in the home. This is a one-story home which consists of 3 bedrooms, 3 bathrooms, kitchen, dining room, living room, front yard (fenced) and backyard . Areas accessible to children are: Living Room, Dining room, Room 1, the restroom in Room 1 and the fenced front yard. Areas off limits: Backyard, Room 2 and Room 3, the kitchen and the other 2 bathrooms located in Room 2 and next to the kitchen. LPA observed child safety knobs on doors of the off limits bedrooms and a child safety gate preventing access to the kitchen. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a landline and a cellphone that is used and the cellphone stays at the facility during operation hours. There is ventilation and heating. LPA observed A/C unit installed in the wall in the living room. Safe toys play equipment and materials were observed. Per the Licensee, the children play and eat in the living room and sleep throughout the dining room, living room and Room #1. Per Licensee, Room #1 is used as needed. The on limits bathroom is in Room #1 and Licensee guides children to the bathroom. The Restroom was observed to be safe and sanitary. LPA advised Licensee to keep all cords from the window blinds inaccessible to children when Room #1 is in use. LPA observed two cribs in the dining room. Per Licensee she does not have any children enrolled that are under 12 months of age. Page 1

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 198020309
	VISIT DATE: 07/02/2021

NARRATIVE

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At 11:06 AM LPA observed the first aid kits. There is one first aid kit (backpack) available in Room 1 and another first aid kit attached to the wall in the dining room. LPA advised Licensee to replenish the backpack kept in room 1 with band aids and tweezers. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children; detergents and cleaning compounds are stored in the kitchen which is off limits. Poisons are locked in a cabinet in the laundry room. At 11:09 AM LPA inspected the fire extinguisher: The valve on the required 2A10BC fire extinguisher indicates fully charged and was serviced on 10/2020, as indicated on service tag. Licensee tested the smoke detector in the living room and the carbon monoxide detector in the dining room at 11:18AM. LPA observed them to be operable. The Licensee states she provides food for children in care

Currently, children are using the front yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided.
Licensee states that she is not currently caring for infants under 12 months of age. Licensee states that infants under 24 months sleep in the dining room in a crib. Appropriate sleeping arrangements and cribs were observed. Two cribs were observed. Cribs or play yard did not hinder the entrance or exit from the sleeping space mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards were observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side of the crib. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 4/10/23. LPA advised that if a child shows signs of illness he/she/they shall be separated from other children.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 198020309
	VISIT DATE: 07/02/2021

NARRATIVE

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The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.
Records for Child #1 and Child #2 were reviewed, including emergency information and were observed to be complete. Records for Child #3 and Child #4 were not available to view. LPA advised Licensee to have all records ready to view at all times.
LPA observed that the Licensee has proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file which was completed on 3/26/20. LPA reminded Licensee to have assistant complete mandated reporter training when hired. Per Licensee, assistant is in the process of obtaining all required documents.

All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 3/24/21. There are no pets on the premises.

LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection.
Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.
LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.
Incidental Medical Services (IMS):
Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free 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.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 198020309
	VISIT DATE: 07/02/2021

NARRATIVE

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LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. LPA also discussed the Provider Information Notices (PINS) on Safe Sleep Awareness: PIN 19-02-CCP, COVID FAQ - PIN 20-11-CCP, Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD. Capacity Handout (Small & Large) was provided during this inspection.
At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

Exit interview was conducted with Licensee, Adriana Lopez. The Licensee was provided a copy of the appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

A copy of the LIC 9213 was given to licensee—Notice of Site Visit.

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.

End of report

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

LIC809 (FAS) - (06/04)

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