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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215642
Report Date: 09/29/2021
Date Signed: 10/04/2021 09:04:46 AM

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 CAREFACILITY NUMBER:
426215642
ADMINISTRATOR:ADRIANA LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 863-3292
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:14CENSUS: 0DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Adriana Lopez TIME COMPLETED:
12:30 PM
NARRATIVE
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On 9/29/2021, Licensing Program Analyst Gigi Reyes conducted an unannounced Required Annual Inspection, met with Licensee and discussed the purpose of the inspection. Prior to inspection, LPA asked pre health screening questions related to COVID 19, Licensee responses indicate there are no COVID 19 exposure in the Family Child Care Home (FCCH). There were no children present during the visit.

LPA and Licensee toured the interior and exterior of the home, there were no children present. The following rooms are accessible to children, family room, hall way, Licensee's office, and back yard. During the tour LPA observed the following, required forms are posted in the prominent location. Fire extinguisher has not proof of purchase and service date. Smoke and carbon monoxide detectors were tested and found functional. Toxins are locked. LPA observed clean, safe and age appropriate toys.

The backyard has openings in both sides of the house, thus, complete physical and visual supervision is required. There are age appropriate toys and play equipment located in the backyard.

LPA reviewed the following documents, Pediatric CPR and First Aid Card expired on 4/2021. License has not renewed the Mandated Reporter Training per AB 1207 which expired on 9/28/2021. Staff has no proof of immunization and does not have a Tuberculosis clearance. Fire and Disaster drill is conducted and logged every 6 months. Last drill was conducted on 4/29/2021. Children’s roster is current.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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 4
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: 09/29/2021
NARRATIVE
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LPA discussed Safe Sleep Regulations with Licensee. Providers must check on sleeping infants (0 to 24 months) every 15 minutes and document their condition. Each infant, up to 12 months of age, must have an Individual Infant Sleeping Plan (LIC 9227) on file, which will document the infant's sleeping habits, usual sleep environment, and the infant's rolling abilities. LPA provided the Safe Sleep Regulation, LIC 9227 and the Sleep Chart.

The Licensee is not providing Incidental Medical Services (IMS). Policy was discussed. 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


Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with Licensee, Adriana Lopez. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing

The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. Please refer to LIC9099D for documentation of deficiencies cited:
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 09/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2021
Section Cited

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Personnel Requirements
(c) 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 Code Section 1596.866. THis requirment is not met as evidenced by:
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During file review, LPA observed Licensee's CPR and first Aid expired. Licensee stated that she took an online course through American Red Cross but could not locate the certificate. LPA explained that there should be an actual/in person training as well. This poses a potential risk to health and safety of children in care.
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Type B
10/11/2021
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training ...
This requirement is not met as evidenced by:
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LPA review of facility records revealed that LIcensee's AB 1207 expired on 9/28/2020 and Assistant has not taken the training. This poses a potential risk to health and safety of children in care.
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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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: 09/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2021
Section Cited

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1597.622
(a) (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... This requirement is not met as evidenced by:
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LPA review of record revealed that assistant has no proof of immunization. This poses a potential risk to health and safety of children in care.
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Type B
09/11/2021
Section Cited

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102369(b)(9)
(9) Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.
This requirement is not met as evidenced by:
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Based on LPA review of record, it was revealed the Assitant does not have the tuberculosis clearance. This poses a potential risk to health and safety of children in care.
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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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2021
LIC809 (FAS) - (06/04)
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