<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364815076
Report Date: 04/29/2019
Date Signed: 04/29/2019 02:50:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
364815076
ADMINISTRATOR:LOPEZ, RUTHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 900-6747
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: 6DATE:
04/29/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Ruth LopezTIME COMPLETED:
03:00 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) Neal met with licensee, Ruth Lopez for the purpose of an Annual/Random inspection. This is a two story 4 bedroom, 2 & 1/2 bathroom home with kitchen, living room, dining room, laundry room and garage. The garage is used for storage only and no child care activities are conducted there. There is a pool on the premises. There are no other residents in the home besides the licensee. Licensee's assistant and 6 child care children were present during this inspection.

Main care is provided in the living room and dining room areas. Children use the bathroom besides the gated stairs. Children have access to a portion of the backyard. Off limits areas include the home's entire gated upstairs, garage and the gated pool area. Fireplace is screened. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines (upper kitchen cabinet), and hazardous items that can pose a danger to children. Cleaning compounds are kept in the garage and the locked laundry room. Sharp knives are kept on top of the refrigerator in a butcher block. Facility roster was observed. A sample of children's records were reviewed.

Children play in the backyard. There are small play structures and age appropriate equipment. There is a concrete area and dirt area for active play. LPA observed pool gate of appropriate height. LPA observed that door to gate does not self close/self latch. Gate opening contains a pad-lock for inaccessibility.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 364815076
VISIT DATE: 04/29/2019
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
26
27
28
29
30
31
32
Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. LPA observed age appropriate toys and napping equipment on the premises. Pack n' plays and mats are provided for napping children. Smoke detector and carbon monoxide detector were observed. Home has central AC and heat. Licensee's CPR/First Aid expired 1/16/2018. LPA observed the parent board and required documents are posted.

The following was discussed with the licensee:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov . Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home and in those areas of the family child care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 364815076
VISIT DATE: 04/29/2019
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
26
27
28
29
30
31
32
Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1st offense and up to $3000.00 for the 2nd offense within a 12 month period, PER PERSON.

Incidental Medical Services (IMS) policy was discussed. 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.htmLicensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent and a copy of the Acknowledgment of receipt of licensing report (LIC9224) must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.


3 Type B deficiencies were cited during this inspection per Title 22 and the health and safety regulations. An LIC 809D was given to the licensee. Appeals rights were given.
Exit interview was conducted, report was read and a copy was provided to the Licensee on this date.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 364815076
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2019
Section Cited
CCR
102417(g)(1)
1
2
3
4
5
6
7
Operation of a Family Child Care Home - Fire extinguishers and smoke detectors shall meet State Fire Marshal standards. This requirement is not met as evidenced by: Licensee's Fire extinguisher
1
2
3
4
5
6
7
Licensee states she will obtain fire extinguisher in operable condition or have current one serviced by POC due date.
8
9
10
11
12
13
14
was in red, in need of servicing which is a potential risk to health and safety of children.
8
9
10
11
12
13
14
Type B
05/24/2019
Section Cited
CCR
102417(g)(5)(A)
1
2
3
4
5
6
7
Operation of a Family Child Care Home - All licensees shall ensure the inaccessibility of pools...gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches
1
2
3
4
5
6
7
Licensee will repair opening to gate so that it self-latches and self-closes and inform licensing by POC due date.
8
9
10
11
12
13
14
from the top of the gate. This requirement is not met as evidenced by LPA observed that pool gate does not self-latch, self-close which is a potential risk to the health & safety to children.
8
9
10
11
12
13
14
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: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 364815076
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2019
Section Cited
HSC
402416(c)
1
2
3
4
5
6
7
The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety
1
2
3
4
5
6
7
Licensee states she will renew her pediatric cpr/1st aid by the POC due date and submit new certificate to licensing.
8
9
10
11
12
13
14
Code Section 1596.866.
This requirement was not met as evidence by: LPAs observed Licensee CPR/First Aid expired 01/16/2018.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5