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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212881
Report Date: 05/16/2024
Date Signed: 05/16/2024 01:34:09 PM


Document Has Been Signed on 05/16/2024 01:34 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:MARTON/LOPEZ FCC AKA CHERISHED MOMENTSFACILITY NUMBER:
566212881
ADMINISTRATOR:PAULA MARTON/SHELLIE LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 982-0619
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY:14CENSUS: 10DATE:
05/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Shellie Lopez TIME COMPLETED:
01:47 PM
NARRATIVE
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On May 16, 2024 at 11:10 AM, Licensing Program Analyst (LPA) Aaliyah Zendejas conducted an unannounced annual/random inspection. LPA met with licensee Shelli Lopez and advised them of the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. At the time of inspection there were 10 children and 4 adults. Licensee denies having guns/ammunition in the home.

LPAs observed required Licensing required documents posted prominently at the entrance. Fire and earthquake drills are being documented every six months. Last drill was conducted on 1/31/2024.. Fire extinguisher 2A10BC mounted on the wall inside the home was last serviced December 19, 2023. Fire and carbon monoxide detectors were tested at 12:03 PM and found to be in working condition.

Children in care have access to one room, one restroom, living room, and enclosed backyard. The upstairs area is off limits to children and is prevented from being accessed via a gate. Children sleep within the one accessible bedroom and each child has their own crib. LPA asked license if they were conducted the 15 minute checks and licensee stated that they were not because they had someone monitoring the children while they slept. LPA also observed canopies draped and attached to each crib.Children have access to toys that are age-appropriate inside and outside of the home. There are no bodies of water present at the time of inspection. During the tour, LPAs did not observe any hazards/toxins items accessible to children in care.

LPAs reviewed 5 children files. All children files were current. Licensee CPR/first aid is valid through 7/26/2025 Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com Licensee's mandated reported had just passed its expiration date. LPA advised licensee to redo mandated reporter training and send as soon as possible. LPA also observed staff's mandated reporter training had also expired in March and advised licensee to send to LPA.


Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Aaliyah ZendejasTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MARTON/LOPEZ FCC AKA CHERISHED MOMENTS
FACILITY NUMBER: 566212881
VISIT DATE: 05/16/2024
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPAs 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. LPAs 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. Licensee does currently have infants in care.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Continued on 809-C

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

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MARTON/LOPEZ FCC AKA CHERISHED MOMENTS
FACILITY NUMBER: 566212881
VISIT DATE: 05/16/2024
NARRATIVE
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During the exit interview, the LICENSEE, Shellie Lopez , confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

The following deficencies were cited:

Type A: 102370 Criminal Record Clearance

and 3 type B violations.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with Shellie Lopez. .

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

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC809 (FAS) - (06/04)
Page: 6 of 6
Document Has Been Signed on 05/16/2024 01:34 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: MARTON/LOPEZ FCC AKA CHERISHED MOMENTS
FACILITY NUMBER: 566212881

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)(3)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects. (3) There shall be no objects hanging above or attached to the side of the crib.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above by having a sheer canopy attached to the cribs which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2024
Plan of Correction
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Licensee has now taken out the canopies and they are no longer attached to the crib.
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview , the licensee did not comply with the section cited above which licensee stated they do not document safe sleep 15 minute checks which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2024
Plan of Correction
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Licensee is to start documenting safe sleep 15 minute checks and keep them within facility. After 2 weeks of checks, Licensee is to send LPA proof of checks.
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: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Aaliyah ZendejasTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6


Document Has Been Signed on 05/16/2024 01:34 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: MARTON/LOPEZ FCC AKA CHERISHED MOMENTS
FACILITY NUMBER: 566212881

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

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 due staff members having expired mandated reporter trainings which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2024
Plan of Correction
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Licensee is to have all staff complete mandated reporter trainings and send proof to LPA by May 31, 2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Aaliyah ZendejasTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024
LIC809 (FAS) - (06/04)
Page: 4 of 6


Document Has Been Signed on 05/16/2024 01:34 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: MARTON/LOPEZ FCC AKA CHERISHED MOMENTS
FACILITY NUMBER: 566212881

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(a)
102370 Criminal Record Clearance (a) Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption.
This requirement was not met as evidence by:
Deficient Practice Statement
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Based on observation, nterview, record review, the licensee did not comply with the section cited above where 1 potential staff member was working unfingerprinted which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2024
Plan of Correction
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Unfingerprinted person is to leave immediately. They are to get fingerprint cleared and associated to the facility if they wish to work. Licensee is to send over documentation to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Aaliyah ZendejasTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024
LIC809 (FAS) - (06/04)
Page: 5 of 6