354403703-3-6-2025-07-CC-PSGZ-DEHT6U-20250306132744

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 354403703
Report Date: 03/06/2025
Date Signed: 03/06/2025 01:28:01 PM

Document Has Been Signed on 03/06/2025 01:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	ALVAREZ, LUPE		FACILITY NUMBER:	354403703
ADMINISTRATOR/ DIRECTOR:	ALVAREZ, LUPE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 537-7854
CITY:	HOLLISTER	STATE: CA	ZIP CODE:	95023
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	03/06/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:42 AM
MET WITH:	Lupe Alvarez		TIME VISIT/ INSPECTION COMPLETED:	01:40 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) Pedro Solorio met with licensee Lupe Alvarez for a required one year visit. LPA explained the nature of today’s inspection to her. Present were licensee, licensee's assistant Ophelia Casarez and 9 day care children including three infant. At 12:19pm, a child was dropped off at the facility. Days and hours of operation are Monday to Friday, 7:00am to 5:30pm. The adults that reside in the home are licensee and spouse Edmund Hopper. A review of staff records on 03/05/2025 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee Lupe Alvarez was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption prior to initial presence in a Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if the regulation is violated. LPA toured the indoor and outdoor areas of the home during today’s inspection. LPA observed that the home is clean and orderly, with heating and ventilation for safety and comfort of the children. LPA observed a barricaded fireplace and wood burning stove in the living room of the home. LPA observed safe and sufficient materials, toys, and play equipment for the day care children. All sharp objects, detergents, cleaning compounds, medications, poisons, and other similar items inside the home are stored inaccessible to children. LPA observed a fully charged 3A40BC fire extinguisher. LPA observed a working smoke detector and a working carbon monoxide detector. Licensee states there are no weapons/firearms in the home. Off limit areas indoor: entire home including master bedroom/bath, two bedrooms, one bath, kitchen, living room and laundry room. LPA observed swim/spa with a locked cover. Backyard is fenced. Off limits outdoor: back and right side of home that is fenced off to children. LPA observed proper Pool Safety requirements for the jacuzzi. Jacuzzi is in the off-limits outdoor area and children are not able to access. Licensee has two dogs that stay in the fenced area of the home and are vaccinated. LPA observed licensee and licensee have a current CPR and First Aid certification expiring 06/2025 and completed Mandated Reporter training on 07/18/2023. Assistant Ophelia Casarez First Aid certificates expires on 06/2025. Ophelia Casarez Mandated reporter was completed on 07/19/2023.

Susy Cervantes
Pedro Solorio-Gutierrez
	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

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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Document Has Been Signed on 03/06/2025 01:28 PM - It Cannot Be Edited

Created By: Pedro Solorio-Gutierrez On 03/06/2025 at 01:08 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: ALVAREZ, LUPE	FACILITY NUMBER: 354403703
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421(a)

Child's Records

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above: in eight children's files were missing LIC 627 and one of the eight was missing MMR vaccine updates which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/20/2025
	Plan of Correction
1 2 3 4	Licensee will submit updated LIC 627 forms and updated MMR vaccine proof to LPA Pedro Solorio. Licensee stated she will have this completed by Plan of Correction due date: March, 20, 2025

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Susy Cervantes

LICENSING EVALUATOR NAME:

Pedro Solorio-Gutierrez

LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

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

FACILITY NAME: ALVAREZ, LUPE	FACILITY NUMBER: 354403703
	VISIT DATE: 03/06/2025

NARRATIVE

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LPA observed a current roster of the children and a fire and disaster drill log which was last completed on 09/23/2024. LPA reviewed ten children's files and children have current immunization records on file. Child 1, 2, 4, 5, 7, 8, 9, and 10 were missing LIC627. Child 2 was missing updated MMR vaccine in file. LIC 9227s and Sleep log were checked for all infants. Licensee states day care is insured and LPA verified current policy. LPA discussed SB792 Immunization Requirements and observed licensee and assistant have immunization records on file. No IMS is administered by the facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Supervision of children was discussed with 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. Licensee understands her capacity options and she understands that she cannot have more than eight children in the home at any time. Licensee understands if she transports children via vehicle, children cannot be left in parked vehicles unattended at any time.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding www.cdss.cs.gov/inforesources/community-care-licensing/inspection-process.

LPA discussed the safe sleep regulations with Licensee Lupe Alvarez and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee Lupe Alvarez of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISOR'S NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Pedro Solorio-Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

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

FACILITY NAME: ALVAREZ, LUPE	FACILITY NUMBER: 354403703
	VISIT DATE: 03/06/2025

NARRATIVE

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Licensee Lupe Alvarez was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE LUPE ALVAREZ confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee Lupe Alvarez

The following type B deficiencie(s) were cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Pedro Solorio-Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

LIC809 (FAS) - (06/04)

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