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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212881
Report Date: 04/06/2022
Date Signed: 04/11/2022 04:50:24 PM


Document Has Been Signed on 04/11/2022 04:50 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/11/2022 12:30 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

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THIS IS AN AMENDMENT OF REPORT ISSUED ON 4/6/2022 TO INCLUDE AN INCREASE OF CAPACITY EFFECTIVE DATE.

On 4/6/22 at 9:17 am Licensing Program Analyst (LPA) MIchael Mathew Conduced an unannounced case management regarding increase of capacity and met with licensee Shellie Lopez. LPA and Licensee toured the home inside and out, and there where 5 children and one adult at the time of the visit. All adults in the home are fingerprinted and background cleared .



Licensee uses one bedroom, one bathroom, living room, kitchen and backyard for care. The home has age appropriate toys and ample amount of space for children in care. LPA observed stairs which is gated and is inaccessible to children. LPA also observed a fireplace which is blocked off and covered by a board which makes it inaccessible to children. Licensee states that there are no guns/ weapons/ or ammunition in the home. LPA observed no bodies of water in the home. LPA observed knives are kept on top of the refrigerator which is inaccessible to children. Chemicals are kept in a cabinet under the sink which is locked and also on the top shelf of the laundry room which is inaccessible to children. The required fire extinguisher 2a10bc was last serviced on 6/29/21. Pediatric CPR and first aid is valid until 7/24/23. Mandated reporter training is valid until 3/22/24 . LPA Observed Children file which are current and completed. There was two infants - C1 and C2 in care. LPA reviewed an Individual Sleeping Plan (LIC9227) on file. The home has 2 Fire alarm and 1 carbon monoxide detectors, which were observed to be outside of the bedroom, fire alarm and carbon monoxide detectors were tested and found to be functional. Last Fire drill was conducted on 1/4/22.

Fire Clearance was granted by Ventura County Fire Department on 3/12/2022.


Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2022
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: 04/06/2022
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Licensee does not provide incidental medical service at this time.. Licensee was reminded a plan for Providing IMS must be submitted to the Department. if licensee provides IMS. 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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 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.

A capacity of 14 for a Large Family Child Care Home is granted effective 4/6/2022.

A notice of site visit was given and must remain posted for 30 days

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee.

No deficiency were cited in todays visit.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
LIC809 (FAS) - (06/04)
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