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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212881
Report Date: 01/29/2020
Date Signed: 01/29/2020 01:58:27 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:MARTON/LOPEZ FCC AKA CHERISHED MOMENTSFACILITY NUMBER:
566212881
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
01/29/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Shellie LopezTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Francisco Pedroza conducted an Annual/Random inspection. LPA met with licensee Shellie Lopez and advised her the purpose of the inspection. LPA and licensee together toured the home. Licensee has a two story home. There was four children in care at the time of the inspection.

The licensee uses the kitchen, living room, and one restroom for the day care. Licensee states that there are no fire arms and ammunition in the home. LPA did not observe toxins/hazards accessible to children in care. LPA observed a fireplace with glass screen in the family room preventing children from having access. LPA observed a secured gate at the bottom of the stairs preventing children from having access. There are age appropriate toys and furniture readily accessible to children. The home has working smoke and carbon monoxide detectors. A 2A10BC fire extinguisher was observed on top of the refrigerator in the kitchen with a last service date of 7/19/19. The backyard is fully enclosed with concrete wall. Licensee has age appropriate toys readily accessible to children. Licensee states that the children are taken to the park around the corner for out door recreation.

Continued on 809-C

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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 2
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: MARTON/LOPEZ FCC AKA CHERISHED MOMENTS
FACILITY NUMBER: 566212881
VISIT DATE: 01/29/2020
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A roster of children in care was observed current and complete. A sampling of children records was reviewed and found current. LPA verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Licensee does not have liability insurance for their facility. Children have signed liability waivers in each file. First-Aid and CPR is current until 6/11/21. Mandated Reporter training is current until 5/19/21. The Fire/Emergency drill was completed on 11/8/19. LPA discussed Incidental Medical Services (IMS) with licensee. Licensee currently does not have children in care that require IMS. LPA provided and discussed AB 2370 Lead Exposer guide and Safe Sleep pamphlet.

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

No deficiencies were cited during today's visit.



THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
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