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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212881
Report Date: 08/28/2024
Date Signed: 08/28/2024 04:50:20 PM


Document Has Been Signed on 08/28/2024 04:50 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: 7DATE:
08/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Shelly LopezTIME COMPLETED:
05:05 PM
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On 08/28/2024, Licensing Program Analyst (LPA) David Roman (D. Roman) conducted an unannounced site visit to the Marton/Lopez FCCH AKA Cherished Moments to follow up on a UIR visit. LPA D. Roman met with licensee, Shelly Lopez and discussed the reason for the visit. LPA D. Roman along with licensee, Shelly Lopez toured the facility inside and out. LPA D. Roman did not observe any health or safety hazards. The facility had 3 staff and 7 children at the time of visit. LPA D. Roman reviewed staff records, infant 15 minute sleep logs, and had an in depth conversation with licensee, Shelly Lopez regarding Mandated Reporting/Child Abuse Reporting. LPA D. Roman obtained copies of children roster. LPA D. Roman contacted parents from UIR prior to visit.

LPA D. Roman reviewed Mandated Reporting documents LIC 9108 Statement Acknowledging Requirement to Report Child Abuse. LPA D. Roman educated licensee, Shelly Lopez on the "Abuse That Must Be Reported" Physical Injury, Sexual Abuse, Neglect, Wilful harming or injuring or endangering a child, and unlawful corporal punishment or injury. LPA D. Roman also reviewed along with licensee, Shelly Lopez, the "Penalty for Failure to Report Abuse" A mandated reporter who fails to make a required report is guilty of a misdemeanor punishable by up to six months in jail, a fine of $1000, or both. [PC 11166(b)]

Licensee, Shelly Lopez understands the facilities responsibility in contacting Child Protective Services, Child Abuse Hotline when another incident similar to the UIR happens to occur again.

Notice of site visit provided.
Exit interview and review of report completed with licensee, Shelly Lopez.

SUPERVISOR'S NAME: Lissete GonzalezTELEPHONE: (805) -56-0400
LICENSING EVALUATOR NAME: David RomanTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024
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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