426215642-12-16-2019-17-CC-EBAY-BJX2N7-20191216163216

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215642
Report Date: 12/16/2019
Date Signed: 12/16/2019 04:32:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	LOPEZ FCC AKA SHOOTING STARS CHILD CARE		FACILITY NUMBER:	426215642
ADMINISTRATOR:	ADRIANA LOPEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 863-3292
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	14	CENSUS: 11	DATE:	12/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Adriana Lopez		TIME COMPLETED:	04:45 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) Elvin Baddley and Licensing Program Manager (LPM) Maria Mueller conducted an unannounced Annual/Random inspection of the abovementioned Family Child Care Home (FCCH). LPA and LPM met with Adriana Lopez, Licensee of the FCCH, and explained the purpose of the inspection. LPA and LPM, in the company of the Licensee, toured the interior and exterior of the FCCH. The home’s dining room, hall restroom and backyard are used for child care, while the home’s bedrooms and laundry room are excluded from child care. At the time of the inspection 11 children are present. Required forms are posted on a bulletin board in the FCCH's living room. LPA and LPM observed a combination smoke and carbon monoxide detector which was tested and found to be operable. FCCH has a regulation fire extinguisher which expired on 8/16/19. LPA and LPM reminded the Licensee to either service or purchase a regulation fire extinguisher annually. FCCH's family room has a fireplace which is screened with metal mesh and inaccessible to children. LPA reviewed the home’s fire/disaster drill log and observed the last fire/disaster drill occurring on 4/1/19. LPA and LPM reminded the Licensee fire/disaster drill are required every six months. Licensee informed LPA and LPM a fire/disaster drill would be completed today. The home was orderly, clean and void of hazardous items. Medication was stored in a cabinet above the refrigerator which is out of the reach of children. LPA observed cleaning compounds in the FCCH's laundry room. The FCCH's backyard has large grass areas which is enclosed by wooden fencing. LPA and LPM reminded the Licensee to ensure supervision when children are in the backyard. Toys and play equipment observed in backyard are age appropriate. No bodies of water were observed on site. A sampling of the children records were reviewed. The records were current and complete. A current roster of children was reviewed by the LPA and LPM. The Licensee's records are also current and complete with a Pediatric CPR and First Aid certification expiring on 7/10/21 The Licensee completed Mandated Reporter training which expires 9/28/20. CONT.809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LOPEZ FCC AKA SHOOTING STARS CHILD CARE	FACILITY NUMBER: 426215642
	VISIT DATE: 12/16/2019

NARRATIVE

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The Licensee stated no firearms and ammunition is stored on site.

The Licensee is not providing 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: www.ada.gov/childqanda.htm

LPA and LPM reviewed and provided Licensee with a copy of “Child Care Providers Guide to Safe Sleep." LPA and LPM reviewed and provided “Effects of Lead Exposure” to be distributed to all families. Licensee was reminded of the responsibility to ensure FCCH is functioning in accordance to regulations which can be accessed on-line at www.ccld.ca.gov.

Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiencies were cited (refer to LIC 809-D). The Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted. A copy of this report was left with Licensee, whose signature is on this form confirms receipt of this document.

The LIC 9213 (Notice of Site visit) was posted during today's visit.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LOPEZ FCC AKA SHOOTING STARS CHILD CARE	FACILITY NUMBER: 426215642
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/16/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/24/2019 Section Cited	1 2 3 4 5 6 7	102417(g)(9)(A)(1) Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. This requirement is not met as evidenced by the following:
	8 9 10 11 12 13 14	Based on the LPA and LPM observation/interview the last fire/disaster drill was conducted on 4/1/18, in excess of six months from the present. This poses a potential risk to health, safety or personal rights of persons in care.	8 9 10 11 12 13 14
Type B 12/24/2019 Section Cited	1 2 3 4 5 6 7	102417(g)(1) 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 the following:
	8 9 10 11 12 13 14	Based on the LPA and LPM observation/interview a fire extinguisher currently in the home expired on 8/16/19. This poses a potential risk to health, safety or personal rights of persons in care.	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: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019

LIC809 (FAS) - (06/04)

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