426215687-6-22-2020-17-CC-RGUL-BQTS4T-20200622133316

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215687
Report Date: 06/22/2020
Date Signed: 06/22/2020 01:34:20 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 FAMILY CHILD CARE		FACILITY NUMBER:	426215687
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	06/22/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Carmen Lopez		TIME COMPLETED:	11:20 AM

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	On June 22, 2020 at 11:00 am, Licensing Program Analyst (LPA) Ruth Gull conducted a Case Management - Licensee Initiated inspection with Carmen Lopez, Licensee regarding her request for capacity increase. Due to the COVID - 19 and Department of Public Health guidelines of social distancing, a tele-video inspection was conducted via Facetime with Licensee Lopez. A virtual tour of the home was made. There were four children in care at the time of the inspection. The licensee uses the living room, dining room and hall bathroom for the day care. Licensee uses 2 bedrooms for napping only. The kitchen, 3 bedrooms and attached garage are off-limits/child safe locks/safety gates. The fireplace in the living room is screened. Licensee uses the back yard for the day care and it is completely enclosed by fences with gates. Licensee has a trampoline in the back yard and it is enclosed by a net which is locked. Licensee does have guns and ammunition and they are stored and locked according to regulations. Licensee's Pediatric 1st Aid/CPR certificates (American Heart Association) are valid through 09/2020. LPA reviewed with Licensee the COVID-19 precautions which Licensee is taking (not permitting children with symptoms of illness to attend, families entering and exiting the home for drop off and pick up one family at a time, routinely disinfecting surfaces indoors and outdoors and regular hand washing throughout the day). CONTINUED ON LIC809-C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Ruth Gull	TELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2020

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

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 426215687
	VISIT DATE: 06/22/2020

NARRATIVE

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Licensee has completed all required licensing requirements to become a large family child care.
A fire clearance was granted on 02/24/20 by the Santa Barbara County Fire Department.

Licensee is reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov. LPA reviewed Capacity and Assistant requirements with Licensee. LPA also reviewed with (and will provide via e-mail to) Licensee with Guide to Infant Safe Sleep and Effects of Lead Exposure pamphlet (to be provided to all current and future parents).

Exit interview was conducted with Licensee. This report will be sent to Licensee via email. LPA requested that Licensee reply to the email confirming receipt of documents within 24 hours, in lieu of Licensee’s signature.

Licensed capacity is increased to 14 children, effective today (06/22/2020).

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Ruth Gull	TELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2020

LIC809 (FAS) - (06/04)

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