274414462-8-21-2019-07-CC-FCJO-BF9VRQ-20190821164020

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274414462
Report Date: 08/21/2019
Date Signed: 08/21/2019 04:40:25 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	LOPEZ, MARIA LOURDES		FACILITY NUMBER:	274414462
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	08/21/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	Maria Lourdes Lopez		TIME COMPLETED:	04:50 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	Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual random inspection to the home today. LPA met with Maria Lourdes Lopez, Licensee, and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 5:00 AM to 6:00 PM. Licensee stated the adults that reside in the home are the Licensee, her spouse Melquiades, her adult son Alexis, and her adult daughter Kimberly. Also in the home resides licensee's minor daughter age 16 years old. LPA observed there were two children in care during today's inspection, included one infant and one preschool age child. Certification for CPR and First Aid Card for Licensee is current and will expire on 2/02/2021. LPA toured the indoor and outdoor areas of the home during today's inspection. LPA obtained a copy of the children's roster today and it is current. LPA reviewed four children files and observed files are complete. LPA observed that Licensee has conducted a fire drill during the last six months. Last fire drill was documented on 7/22/2019. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas inside are: Three bedrooms, one bathroom, and the attached garage. LPA observed the laundry area is located in the garage. Off limits areas outside: The back yard which is fenced. Licensee keeps three dogs in the fenced off limits back yard. Licensee stated the dogs are vaccinated. Licensee uses the front and right side yards as playground for the children in care. LPA observed a fully charged 2A10BC fire extinguisher and at least one working smoke detector. LPA observed the home has a carbon monoxide detector. LPA observed there are not stairs in the home. LPA observed the home does not have wall heaters, or bodies of water. LPA observed the home has a barricaded fireplace in the on limits area. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. LPA discussed Incidental Medical Services with licensee. According with the SB792, Licensee has proof of immunization for herself for pertussis, measles, and influenza. *******************Report dated 08/21/2019 continues in page 2.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LOPEZ, MARIA LOURDES	FACILITY NUMBER: 274414462
	VISIT DATE: 08/21/2019

NARRATIVE

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Report dated 08/21/2019 continues from page 1

A review of staff records on 08/20/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and. child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 8 children in the home at any time, and ratio (age of the children) must be observed. The Licensee states that she does not transport children via vehicle and that she understands that children cannot be left in parked vehicles unattended at any time. Licensee uses redirection and communication with children as a form of discipline.
Department website: www.ccld.ca.gov provided to Licensee. LPA discussed the requirements of AB 633 whenever a Type A deficiency is cited. LPA also discussed "zero tolerance" related regulations with the Licensee. LPA observed that the Licensee has completed the "Mandated Reporter" training on 11/13/2017 and was advised that all adults in contact with children are required to complete the "mandated reporter" training. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information on the online training.
LPA advised licensee of the pending Department regulation update re: Safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.
LPA printed forms LIC279 and LIC279B and handed to Licensee for she to update the information on the adults and minors residing in the home.

There were not deficiencies cited during today's inspection. Licensee's rights form was printed in English and Spanish and was handed to Licensee. Exit interview was conducted with licensee in Spanish.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019

LIC809 (FAS) - (06/04)

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