566212881-7-16-2021-17-CC-FPEA-C4YTCB-20210716143627

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566212881
Report Date: 07/16/2021
Date Signed: 07/16/2021 02:36:32 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 MOMENTS		FACILITY NUMBER:	566212881
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	07/16/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:53 PM
MET WITH:	Shellie Lopez		TIME COMPLETED:	02:45 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	On July 16, 2021 at 1:56 PM, Licensing Program Analysts (LPA's) Francisco Pedroza and Austin Rios conducted an unannounced Annual/Random inspection. Prior to LPA's entering the facility, LPA's contacted licensee via phone and conducted Covid-19 screening question. LPA's met with Licensee Shellie Lopez and advised the purpose of the inspection. Licensee provided LPA's a tour of the facility inside and out. There was three (3) children in care at the time of the inspection. The licensee is currently using the living room, family room, one bathroom, and backyard for children in care. Licensee has a gate at the bottom of the stairs preventing children from going up stairs. LPA's did not observe any toxin/hazards accessible to children in care. Licensee has the disinfectants/cleaners under the sink secured with a child safety latch. LPA's observed a 2A10BC fire extinguisher with a service date of 6/29/21 on top of the refrigerator readily accessible. Licensee stores their knifes on top of the refrigerator as well preventing children from having access. LPA observed a fireplace in the living room with a glass door and metal screen preventing children from having access. The facility has working smoke and carbon monoxide detectors. LPA observed age appropriate toys and furniture readily accessible to children in care. The backyard is enclosed by a concrete wall and wood fence. LPA's observed age appropriate toys and structures in the backyard readily accessible to children in care. Licensee advised there are no firearms or live ammunition in the home. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021

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: MARTON/LOPEZ FCC AKA CHERISHED MOMENTS	FACILITY NUMBER: 566212881
	VISIT DATE: 07/16/2021

NARRATIVE

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LPA observed the facility roster and identified that it was current. A sampling of children records were reviewed and found to be current. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Licensee's Pediatric CPR/First-Aid certificate is current and valid until 7/3/2023. Licensee's Mandated Reporter certificate recently expired. Licensee advised to they must renew their Mandated Reporter certificate. The last fire drill was completed on 7/12/2021. LPA's discussed current Safe Sleep and Covid-19 requirements with licensee.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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 inspection.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021

LIC809 (FAS) - (06/04)

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