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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845168
Report Date: 10/13/2023
Date Signed: 10/16/2023 03:22:04 PM


Document Has Been Signed on 10/16/2023 03:22 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
364845168
ADMINISTRATOR:LOPEZ,LILIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 213-8863
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY:14CENSUS: 10DATE:
10/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Liliana LopezTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Rachel Zeron arrived at the facility to conduct an annual inspection and inspect the Licensee's converted garage that has been cleared by the Chino Valley Fire Department on 09/26/2023. 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: Monday through Friday 7:30 am - 5:30 pm
OFF-LIMIT AREAS INCLUDE: Living room, Kitchen, all bedrooms, Laundry room, hallway bathroom
· The facility is operating within the licensed capacity and appropriate ratios
· The Licensee and assistant provider are present in the home and have ensured that children in care are supervised at this time
· A working telephone is present
· Fully-charged fire extinguisher is available at the facility. Smoke detector and carbon monoxide detector are present and were tested by the licensee during this inspection and found to be functioning.
· All hazardous items are inaccessible, this includes: detergents, cleaning compounds, and other items which could pose a danger to children
· Storage of poisons is inaccessible to children and locked
· There is a properly barricaded fireplace
· Weapons are not present. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· Home is clean and orderly, with air-conditioning and ventilation for safety and comfort


· Safe and appropriate toys and equipment are present for both indoor and outdoor activities.
· The side Yard and the backyard Outdoor play areas are fenced or appropriate supervision is present
· Verification of control of property on file (owner)
· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted
· Pediatric CPR and First Aid Card expires 12/2023
· Health & Safety Certificate - completed
Mandated Reporter expires 11/2023
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951)320-2023
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 364845168
VISIT DATE: 10/13/2023
NARRATIVE
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·There are no bodies of water at this time. 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.

Clean, safe and age appropriate toys

Documentation of fire drills on file. The most recent disaster drill was conducted on 10/06/2023

· Each child’s file contains a copy of the emergency information card with required information

The Department was granted inspection authority as required by the Health and Safety Code

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section1596.871, 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 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 this regulation is violated. LPA observed Staff 1 interacting with the children at the facility and was not fingerprint cleared. A citation and civil penalty was issued.

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-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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.

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:

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951)320-2023
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 364845168
VISIT DATE: 10/13/2023
NARRATIVE
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 Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/. MyChildCarePlan.org – Centers and Family Child Care Homes. Licensee [or facility representative] 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.

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 the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

See LIC809-D for cited deficiencies.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. The converted garage area was inspected and meets Title 22 regulations. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Liliana Lopez.

LPA informed Licensee that this report dated 10/13/2023 document(s)  (1) Type A citation which shall be posted for 30 consecutive days as there are immediate risk(s) to the health, safety, or Personal Rights of children in care. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) was provided to facility during this inspection. LIC 9224/Type A citation(s) must be provided to parents/guardian of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for the verification.

A civil penalty has been assessed during this inspection, payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. You will receive an invoice in the mail. Do not send money until you receive your invoice. Do not send cash.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951)320-2023
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/16/2023 03:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 364845168

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 3 staff files which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/14/2023
Plan of Correction
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Licensee agreed to have Staff 1 fingerprinted. Staff was fingerprinted in January 2023, Guardian requested additional documentation from the applicant and documentation was never received. Staff 1 left during LPA visit and will not return until clearance is granted. Licensee will write a letter of understanding in regards to HSC 1596.871 and submit it to Licensing by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Aaron RossTELEPHONE: (951)320-2023
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 10/16/2023 03:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 364845168

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 3 staff which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/27/2023
Plan of Correction
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Licensee agrees to obtain a copy of staff 1's immunization record reflecting TDAP vaccine and a current TB test. Licensee will send a copy of the documentation by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Aaron RossTELEPHONE: (951)320-2023
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5