304310195-8-22-2019-06-CC-MMAK-BFARJ5-20190822130323

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304310195
Report Date: 08/22/2019
Date Signed: 08/22/2019 01:03:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	LOPEZ, MARIA LENY		FACILITY NUMBER:	304310195
ADMINISTRATOR:	LOPEZ, LENY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 713-2591
CITY:	RANCHO STA MARGARITA	STATE: CA	ZIP CODE:	92688
CAPACITY:	14	CENSUS: 8	DATE:	08/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Licensee		TIME COMPLETED:	01:15 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	Pg 1 An inspection was conducted at the facility by Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek. LPA met with licensee, Maria (Leny) Lopez and her spouse, Manulito (Manny) Lopez. Census was taken. There were a total of 8 children of whom 3 were under two years old. The children were eating lunch in the dinning room area. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are presently two other adults living in the home besides the licensee. During today’s inspection the home and grounds were toured and the licensee was operating within the licensed capacity. The floor plan was verified. Off limits areas are made inaccessible by means of baby gates and locks. The kitchen area was separated by a baby gate. The facility is a two story home. The primary area of day care is one bedroom, family room, dinning room, and a bathroom which are all located downstairs. The smoke detector, carbon monoxide detector, and fire extinguisher are within regulations. The backyard designated for outdoor play for children in care is fenced. There are no bodies of water, and no pets on the premises. The pediatric CPR/First Aid, for the licensee, and her spouse's certifications are current. Items which could pose a danger to children were not accessible to children. Poisonous items were not observed during today's inspection. The licensee has a current roster of children in care. Emergency Disaster drill log within the past six months was available. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. Children's records: parents' rights and California School Immunization Record were reviewed. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. Continued on page 2

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LOPEZ, MARIA LENY	FACILITY NUMBER: 304310195
	VISIT DATE: 08/22/2019

NARRATIVE

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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 .

Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov
A copy of child care provider's guide to safe sleep pamphlet and a copy of Never Ever Shake a Baby pamphlet with the website www.dontshake.org were given to the facility representative on the last inspection.
An updated pamphlet regarding safe sleep regulations in childcare and a pamphlet for lead poisoning facts were given to the director today.

Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.
Mandated Reporter Training was discussed with the licensee. This course is not offered in the licensee's native language online. This training is offered at Department's website at www.ccld.ca.gov under Mandated Reporter Training for childcare providers SB1207
No deficiency was cited.

Exit interview was conducted.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

LIC809 (FAS) - (06/04)

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