364807964-6-30-2023-09-CC-DBRL-CTB3AA-20230630180425

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364807964
Report Date: 06/30/2023
Date Signed: 06/30/2023 06:04:33 PM

Document Has Been Signed on 06/30/2023 06:04 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	LOPEZ FAMILY CHILD CARE		FACILITY NUMBER:	364807964
ADMINISTRATOR:	LOPEZ, FRANCISCA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 823-4539
CITY:	FONTANA,	STATE: CA	ZIP CODE:	92336
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	06/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:55 PM
MET WITH:	Francisca Lopez		TIME COMPLETED:	06:10 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 date and time listed, Licensing Program Analyst (LPA) Diana Brasel arrived at the facility to conduct a one year annual inspection as part of a compliance review. Upon arrival LPA was granted access by the licensee, 5 children were observed and the licensees qualified assistant was present. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed: Normal days and hours of operation are: 7 days a week up to 23 hours if needed. OFF-LIMIT AREAS INCLUDE: The licensee is not provided over night care presently. Overnight care requirements have been discussed previously. Off-limit areas indoors include: The room off of the living room, the laundry room, the restroom beyond the laundry room, the music room that is accessible from the restroom past the laundry room, and the licensees bedroom. Off-limit areas outdoors: The gated back portion of the property and the west side of the facility. The pool area is off limits, gated and locked. The facility is operating within the licensed capacity and appropriate ratios · Appropriate supervision provided during this inspection · A working telephone is present and current number on file · Appropriate fire extinguisher, smoke detector and carbon monoxide detector present and were tested. · Fireplace is properly screened to prevent access by children · All hazardous items are inaccessible to children · Toxins are locked outside in cabinet. · No weapons per the licensee. · The facility is a single floor home · Verification of control of property on file · Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Diana Brasel
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 364807964
	VISIT DATE: 06/30/2023

NARRATIVE

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· Mandated Reporter Training was completed for Licensee and Assistants Child Care Provider expired on 06/23/2023 (licensee/assistant stated, they will update by 07/10/2023) Licensees General taken 05/27/2018- Assistant General taken 05/27/2018 & 06/22/2021.
· Pediatric CPR and First Aid Card expires for both licensee and assistant on 03/29/2025.
· Health & Safety Certificate - completed and a copy is maintained in facility file.
There is an in-ground pool located behind the house with a 5 foot wrought iron fence. The gate is self-closing and self-latching. The gate meets Title 22 Regulations. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position. LPA checked the gate at time of visit.
· Clean, safe and age-appropriate toys are present
· Current roster on file
· Documentation of fire and disaster drills on file – Last drill conducted on 06/04/2023.
· Children’s records are complete
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· Resident and/or staff records reviewed on 06/30/2023 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

- LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

- LPA also informed licensee 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.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Diana Brasel
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 364807964
	VISIT DATE: 06/30/2023

NARRATIVE

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No IMS currently - 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: http://www.ada.gov/childqanda.htm

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

- Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at:

https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.

No cited deficiencies during this inspection.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

The LICENSEE, Francisca Lopez confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Exit interview conducted, appeal rights provided, and report was reviewed with the licensee Francisca Lopez.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Diana Brasel
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

LIC809 (FAS) - (06/04)

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