274414462-6-5-2020-07-CC-SCES-BQAU3K-20200605151339

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274414462
Report Date: 06/05/2020
Date Signed: 06/05/2020 03:14:14 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: 1	DATE:	06/05/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Maria Lourdes Lopez		TIME COMPLETED:	03:15 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 6/5/2020 at 2:00 PM, Licensing Program Analyst (LPA), Susy Cervantes, through tele-visit met with licensee, Maria Lourdes Lopez, for a case management inspection for an increase in capacity. Tele-visit was conducted due to Covid-19. Prior to this inspection, LPA received an approved fire clearance dated 5/8/2020 from the King City Fire Marshal. Present was Licensee with one child in care: one preschool. Adults living in the home are Licensee and her husband Melquiades, her son Alexis, and her daughter Kimberly with one child age 17 years. Days and hours of operation are Monday through Saturday, 5:00 am to 4:00 am. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 06/05/2020 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100 per person per day, minimum of $100 to a maximum of $500 per person for an initial violation, and a minimum of $100 to a maximum of $3000 per person for any subsequent violation within a 12-month period. LPA toured the inside and outside of the home. LPA observed a covered fireplace, no wall heater and no stairs. Off limits indoor: 2 bedrooms, master bedroom, master bathroom, living room, attached garage and kitchen. There are no bodies of water. Licensee stated there are no firearms/weapons in the home. LPA observed a 2A10BC fire extinguisher that is fully charged and was serviced on 8/14/19. Smoke detector and Carbon Monoxide detector are operable. LPA observed the fire department pull station near the front door entrance. Telephone is in working order. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children and stored top kitchen cabinets and the garage. Backyard is fenced. There are three dogs, licensee stated they are vaccinated. Off limits outdoor: back yard, children use the fenced front yard and right side yard for out door play time. The outdoor emergency exit is on the right side yard. *Continues on report dated 06/05/2020*

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2020

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: 06/05/2020

NARRATIVE

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Continuation of report dated 06/05/2020

LPA reviewed the ratio/capacity for a large family child care home with the licensee and emailed a copy of the chart. Licensee stated that she does not transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.

LPA observed a current roster for the children in care. LPA observed a fire and disaster drill log that was last conducted on 5/18/20. LPA observed that the Licensee has completed Mandated Reporter training on 3/6/19. Licensee has Pediatric CPR/1^st Aid expiring 2/2/21. Licensee has all needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza (decline statement) as well as TB testing. Incidental Medical Services (IMS) policy was discussed with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

Licensee was reminded that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. LPA discussed the immediate civil penalties for Zero Tolerance of $500. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPAs provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. Safe sleep was discussed with the Licensee and Guide to Safe Sleep information was provided to the licensee. Department website: http://ccld.ca.gov provided to Licensee.

Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.
An exit interview was conducted with Licensee in Spanish. LPA informed Licensee that her report, appeal rights, and notice of site visit will be emailed to her. Licensee understands that in lieu of a signature, a read receipt or confirmation of receiving the report email must be submitted within 24 hours.
No deficiencies were cited during today’s inspection. Notice of site visit must remain posted for 30 days. LPA advised licensee that the request for an increase of capacity will be issued pending Management Approval.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2020

LIC809 (FAS) - (06/04)

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