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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212546
Report Date: 08/11/2023
Date Signed: 08/13/2023 09:30:30 PM


Document Has Been Signed on 08/13/2023 09:30 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
566212546
ADMINISTRATOR:MARIA LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 223-5334
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY:14CENSUS: 8DATE:
08/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria LopezTIME COMPLETED:
02:50 PM
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On 08/11/2023, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced One Year Required Inspection of the Family Child Care Home (FCCH). LPA met with Maria Lopez, licensee FCCH and explained the purpose of the inspection. LPA, in the company of licensee toured the interior and exterior of the FCCH. LPA notes eight (8) children were present at arrival being cared by licensee.

This is a single-story home with three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen, garage, and outdoor yard. The daycare services occur in the living room, kitchen, dining area, one (1) bathroom and outdoor yard. Meanwhile, the three (3) bedrooms, one (1) bathroom, garage and part of the outdoor yard are inaccessible to children in care. LPA observed bedroom door to be locked. The garage is off limits and only has an entrance through the street of the home. LPA observed part of the outdoor yard is inaccessible by means of a fence.

LPA observed the home to be orderly. There is plenty of ventilation to afford the children comfort. LPA observed sharps are stored in an elevated cabinet in the kitchen. Cleaning compounds are stored in the laundry closet that is locked and under the sink of the bathroom that was found locked. Medication for the family is stored in an elevated cabinet in the kitchen. LPA notes all areas are inaccessible to children in care. The restroom that is used for childcare services is clean and free of toxins. In the FCCH, LPA observed toys, furniture, and equipment are in good conditions and are age appropriate for the children in care.

Required forms are predominantly posted in the living room. LPA observed a combination smoke and carbon monoxide detector in the FCCH that were tested at 1:00 PM and was operable during this inspection. LPA observed the home has a regulation fire extinguisher that was purchased on 8/11/23. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The home maintains working telephone services. Licensee informed LPA guns and ammo are stored in the home. LPA observed guns are stored in a large safe that requires a numerical code to open. LPA observed ammo is stored separately in a small box that has a lock that requires a key to open. LPA observed guns and ammo are not stored together.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2023
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: 566212546
VISIT DATE: 08/11/2023
NARRATIVE
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LPA observed the outdoor yard to be completely fenced. LPA observed the exit doors to be secured. LPA observed that part of the outdoor yard is made inaccessible by means of fencing. The outdoor yard provides plenty of shading for the children in care. Licensee will be removing broken items from the outdoor yard. Filtered drinking water is provided by means of individual cups that are labeled. Toys, furniture, and equipment observed in the outdoor yard are age appropriate and in good conditions. No bodies of water are observed.

LPA reviewed Licensee, and children's records. The children’s records were found to contain emergency contact information as well as immunization records. Licensee is not documenting infant 15-minute sleep logs for all children under the age of two (2) years. Licensee reported that she is not collecting LIC9227 for all infants under the age of 1 year. Licensee currently has infant age children enrolled. LPA collected a copy of the facility roster that contained the names of all children present during inspection. The last emergency drill was conducted and documented on 07/09/2023. LPA reviewed Licensee’s Pediatric First -aid certificate that expires 10/8/24 and Licensee's Mandated Reporter training certification is valid until 08/15/2023. Licensee understands that she has 4 days to update mandated reporter certificate.

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. 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: http://www.ada.gov/childqanda.htm



Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023
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: 566212546
VISIT DATE: 08/11/2023
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for additional resource. LPA also informed Licensee 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. LPA recommends licensee attend infant safe sleep training through CDR.

During today’s inspection deficiencies are being cited.

Exit interview and review of report was conducted in Spanish by LPA Velazquez with licensee, Maria Lopez. Notice of site visit and appeal rights were provided to licensee.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/13/2023 09:30 PM - It Cannot Be Edited

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: 566212546

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)(2)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that Licensee does not have LIC9227 for all children under the age of one year which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/18/2023
Plan of Correction
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Licensee agrees ensure all children under the age of one year have LIC9227 and will submit proof via email to Francisca.Velazquez@dss.ca.gov by 8/18/23.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that licensee is not documenting 15 min checks for all infants under the age of 2 years which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/18/2023
Plan of Correction
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Licensee agrees to start documenting 15 min checks for all infants under the age of two years and will submit proof via email to Francisca.Velazquez@dss.ca.gov by 8/18/23.
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: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2023
LIC809 (FAS) - (06/04)
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