<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911571
Report Date: 03/24/2022
Date Signed: 03/25/2022 11:28:01 AM


Document Has Been Signed on 03/25/2022 11:28 AM - 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, 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: 13DATE:
03/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Licensee, Victoria LopezTIME COMPLETED:
03:30 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
A case management inspection was conducted on 3/24/2022 by Licensing Program Analyst (LPA), Stefanie Galvan. LPA met with, licensee Victoria Lopez to discuss an incident which occurred on 3/4/2021. A complete file review was conducted prior to visit. LPA toured this facility inside and outside and a census was taken. LPA interviewed staff and observed the area in which incident occurred.

On 3/24/2022, at approximately 10:32am a child grabbed a bottle of bleach solution and sprayed another child in the face. Licensee's assistant witnessed the incident and immediately removed the spray bottle. The child’s parent was notified and the licensee reported the incident to Community Care Licensing as required. No medical treatment was needed and poison control was contacted. Licensee is reminded that hazardous items must not be in reach of children at any time. Licensee agrees to report any further incidents and maintain a home free of hazardous chemicals while children are in care.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency is being cited for today's visit.

An exit interview was conducted with licensee.

END OF REPORT
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Stefanie GalvanTELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
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 1