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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412942
Report Date: 08/31/2023
Date Signed: 08/31/2023 12:51:41 PM


Document Has Been Signed on 08/31/2023 12:51 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:LOPEZ, AMALIAFACILITY NUMBER:
434412942
ADMINISTRATOR:LOPEZ, AMALIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 420-2646
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:14CENSUS: 7DATE:
08/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Amalia LopezTIME COMPLETED:
01:15 PM
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On 08/31/23 at 10:00 AM, Licensing Program Analyst (LPA) Teodoro Trujillo met with licensee Amalia Lopez, for an annual inspection. Present with licensee were assistant Maria and spouse who left during site visit, with 7 children: three (3) Infants, four (4) preschool age. Adults living in the home are licensee, her spouse Juan and adult son and her 3 minor children ages 17, 15 and 7 years old. Days and hours of operation are Monday through Friday 06:00 AM to 5:00 PM.

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 08/16/2023 was reviewed and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. Licensee Amelia Lopez 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 section 1596.871, 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 inspected inside and outside of single-story home. Licensee owns the home and Licensee states she has liability insurance for a family childcare home (FCCH). LPA observed a 3A40BC fire extinguisher last serviced on 09/08/22. Carbon Monoxide and smoke detectors are operable. LPA observed no wall heater, and no fireplace. Licensee stated there is no firearms/weapons in the home. Sharp objects, medicines, poisons, and cleaning supplies are inaccessible to the children. Off limits indoor: bedroom 1, bedroom 2, and bedroom 3 with bathroom. Backyard is fenced. LPA observed the stairs to the upper deck in the backyard is barricaded from the bottom. LPA observed a locked storage shed in the upper deck. Off limits outdoor: the upper deck and the right-side yard. LPA observed a covered parking port next to the kitchen outside the home. Licensee also understands her ratio and capacity options. Children were supervised during the visit and LPA went over substitute options and reminded licensee they could only have 14 children according to her license. Licensee stated she does not transport children, LPA reminded Licensee that children are never to be left in parked vehicles and must use appropriate car seats according to the child's age/weight/size.

Continues report dated 08/31/2023 pg. 1/3

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023
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 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LOPEZ, AMALIA
FACILITY NUMBER: 434412942
VISIT DATE: 08/31/2023
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Continuation of report dated 08/31/2023 pg. 2/3

LPA observed a current roster of the children. LPA observed a fire and disaster drill log last performed on 7/24/2023. LPA reviewed 5 children’s files and observed all required documentation was in compliance. Infant individual sleeping plan (LIC 9227) for each infant under 12 months was discussed. LPA observed licensee completed Mandated Reporter Training on 3/19/22, assistant Maria completed on 7/26/22. Licensee has Pediatric CPR/1st Aid expiring on 09/04/2023 and assistant Maria expires on 7/26/24 Needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza as well as TB testing is current for licensee, and all adults residing in the home.

Incidental Medical Services (IMS) policy was discussed with the licensee. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The licensee is not providing IMS currently. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.

LPA discussed the safe sleep regulations with licensee Amalia Lopez 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 Amalia Lopez 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.



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.

Continues report dated 08/31/2023 pg. 2/3
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LOPEZ, AMALIA
FACILITY NUMBER: 434412942
VISIT DATE: 08/31/2023
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Continuation of report dated 08/31/2023 pg. 3/3
Licensee Amalia Lopez 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.

During the exit interview, the Amalia Lopez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No Deficiencies were cited during today's visit.



Exit interview conducted and report was reviewed with the licensee Amalia Lopez.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Teodoro TrujilloTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3