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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312144
Report Date: 07/22/2022
Date Signed: 07/22/2022 08:56:49 AM


Document Has Been Signed on 07/22/2022 08:56 AM - It Cannot Be Edited

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, MARTHA D.FACILITY NUMBER:
304312144
ADMINISTRATOR:LOPEZ, MARTHA D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 543-4922
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:14CENSUS: 7DATE:
07/22/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:Martha Lopez - LicenseeTIME COMPLETED:
09:20 AM
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Licensing Program Analyst (LPA) Carmen Odom arrived at the facility for the purpose of a proof of correction visit.

LPA Odom was greeted by Martha Lopez, Licensee, census was taken there were a total of 7 children present, which were, 2 infants, 3 preschool age children and 2 school age children. Facility was observed to be within ratio and capacity.

A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA Odom conducted an annual random inspection on 07/11/22 where the licensee was cited for having child #2 in a baby bouncer chair in the childcare facility. LPA Odom informed licensee that Baby Bouncers, Baby Walkers, Johnny Jumpers or ExerSaucer are not permitted in the childcare facility. During LPA’s facility inspection LPA did not observe baby bouncer on the premises.

No citations were issued during today's inspection.

A notice of site visit was issued and Licensee Martha Lopez was informed failure to post for 30 days will result in a $100.00 civil penalty fee. An exit interview was conducted with Licensee Martha Lopez and appeal rights were issued and explained.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
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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