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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911571
Report Date: 07/21/2021
Date Signed: 07/21/2021 02:01:21 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:LOPEZ, VICTORIA FAMILY CHILD CAREFACILITY NUMBER:
503911571
ADMINISTRATOR:LOPEZ, VICTORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 672-7832
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:14CENSUS: 0DATE:
07/21/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Victoria LopezTIME COMPLETED:
02:10 PM
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Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On July 21, 2021, Licensing Program Analysts (LPAs), Norma Lomeli and Roman Iglesias met with Applicant, Victoria Lopez for a pre-licensing/change of location inspection. Applicant, her husband and two minor children reside in the home. Verified licensee CPR and First Aid was completed through American Heart Association and expires on February 13, 2023. Licensee’s Assistant, Alyssa Cates completed the training through American Heart Association and expires on July 10, 2023. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on July 12, 2021.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
  • Fire clearance was received on July 12, 2021. Fire alarm is located in the home’s living room (day care room) wall.
  • This is a two story, three bedrooms and two and a half bathrooms home and upstairs area will be off-limits to the day-care children. There is a gate at the bottom of the stairs making upstairs area inaccessible. Care and supervision will be provided in living room (day care room), kitchen and downstairs bathroom. The day care has a separate entrance on the left hand side run of the home. Off-limits rooms/closets are made inaccessible by use of a plastic door knob covers and a child proof safety gate.
  • There is a fireplace in the family room that applicant states it will not be used during day-care hours.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: LOPEZ, VICTORIA FAMILY CHILD CARE
FACILITY NUMBER: 503911571
VISIT DATE: 07/21/2021
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  • LPAs observed children size furniture, games, safe toys, books, arts and crafts supplies for the day care children. There is a flat screen television mounted onto the wall in the day care room. There is two high chairs in the kitchen. Children will nap in the day care room on cots. Applicant understands she is to supervise children at all times.
  • Facility has 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
  • Knives are stored in the kitchen on a top shelf inside the knife block. Medications and cleaning compounds are stored inside a hallway cabinet that is made inaccessible by the use of a child proof safety gate and a magnetic lock.
  • Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
  • Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
  • There are no bodies of water in the home or premises.
  • There is a pig kept inside a backyard fenced area. There is a goat that is kept inside a kennel and will be accessible to the day care children. There are three ducks kept inside a fenced area. Applicant is advised it is her responsibility to ensure the safety of children in care at all times from the pets.
  • Firearms are stored in accordance with Title 22 Regulations and ammunition is stored separate in accordance with Title 22 Regulations.
  • Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
  • Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
  • Applicant states she will or will not be transporting day care children. Applicant understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: LOPEZ, VICTORIA FAMILY CHILD CARE
FACILITY NUMBER: 503911571
VISIT DATE: 07/21/2021
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  • Fenced backyard has a Kid Kraft swing/slide play structure, a geometric climbing dome structure, Little Tikes toddler play structure, Step 2 water tables. LPAs also observed a Little Tikes trampoline with a netted enclosure, applicant understands that she must follow the owner's manual instructions if day care children will have access to the trampoline.
  • SB 792 immunizations verified and on file.
  • Applicant completed the Mandated Reporter Training on February 17, 2019. Licensee’s assistant has not completed the training. Applicant understands that the training needs to be updated every two years.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.
  • 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.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. She is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 7:30 AM to 5:30 PM and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.



(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: LOPEZ, VICTORIA FAMILY CHILD CARE
FACILITY NUMBER: 503911571
VISIT DATE: 07/21/2021
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Applicant is advised the following items must be corrected and documentation be sent to CCL within the next 30 days to avoid possible withdraw.
  • Applicant and applicant’s assistant will complete the Mandated Reporter Training.

Pending verification of corrections of the above items and a final review of her application; Provisional License for a Large Family Day Care Home capacity of 14 children ages under 18 years will be issued for 90 days, pending receipt of the Preventive Health and Safety Training certification.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC809 (FAS) - (06/04)
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