414004519-7-16-2020-05-CC-LGOZ-BRKV6E-20200716160925

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004519
Report Date: 07/16/2020
Date Signed: 07/16/2020 04:09:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	LOPEZ, OLGA E.		FACILITY NUMBER:	414004519
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	07/16/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Licensee, Olga E. Lopez		TIME COMPLETED:	02:00 PM

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THE FOLLOWING INSPECTION WAS CONDUCTED VIA TELE- INSPECTION DUE TO THE COVID-19 SHELTER-IN-PLACE ORDER.

On 7/16/2020 at 1:15P.M., Licensing Program Analyst (LPA), Luis J. Gomez met with licensee, Olga E. Lopez. The purpose of the inspection was explained and is for a Case Management inspection for an Increase in Capacity. Present is the licensee caring for five children; Two school age, one preschool age and two infant age. Licensee stated one of the preschool children is her own child. All adults in the home have proper criminal record clearances on file. Day-care Areas are: First Floor: Facility Kitchen, Outdoor Play Area and Living Room (Playroom) Off-limit Areas are: Entire Second Floor: Bedroom #1, Bedroom #2, Bedroom #3 and Bathroom #2. LPA inspected home with licensee for health and safety hazards.

At 1:20P.M., LPA observed the following: Day-care area has age appropriate toys, book and puzzles for the children. All furniture and playthings inspected are in good repair. There are child size tables and chairs available in the kitchen for snack and activities. All off-limit areas, including access to upstairs, are properly barricaded with child safety gates. Licensee has several infant cribs and cots stored in the playroom. LPA observed Playroom is free of hazards or dangerous conditions. Bathroom #1 is maintained clean and is in working order. Bathroom #1 has adequate supplies for the children. Accessible lower cabinets in bathroom #1 and kitchen have child safe locks installed to prevent access. Toxins, detergents and cleaning supplies are stored in a locked cabinet in the kitchen.

(Continuation on 809-C)

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2020

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LOPEZ, OLGA E.	FACILITY NUMBER: 414004519
	VISIT DATE: 07/16/2020

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At 1:25P.M., LPA observed the outdoor play area in completely enclosed. Licensee has a variety of tricycles, playhouses and playthings that are in good repair. LPA observed area has adequate shading and a soft turf for added safety. Utility shed, located in the outdoor play area, is made inaccessible. Home does not have a swimming pool, spa, hot tub, fishpond or any other bodies of water.

At 1:27P.M. LPA observed an large Aloe Vera plant located on a table in the outdoor play area. The outlets and trash cans located in the day-care in the facility are properly covered. Home has a cell phone, smoke detector, carbon monoxide detector and a fully charged fire extinguisher (2A:10BC) located in the kitchen.

Licensee was reminded that when operating at a large capacity, there must be a helper present. Capacity limits were discussed with the licensee during inspection.

Prior to approval of large capacity, licensee must complete the following:

- Make all hazardous items in the backyard area inaccessible

- Submit all original required documents with licensee signatures

- Submit facility’s fire clearance approval (STD 850)

- Submit updated copy of lease agreement for licensed address

- Submit renewed CPR/ 1^st aid Certification

- Submit updated Current children in your home list (LIC 279B)

- Submit Pre-licensing Readiness Guide (LIC 9150)

- Submit proof of licensee’s required immunization

This report must be available in the facility for public review. Notice of site visit was observed being posted. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2020

LIC809 (FAS) - (06/04)

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