566213467-1-17-2020-17-CC-BCES-BKWNU2-20200117094536

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566213467
Report Date: 01/17/2020
Date Signed: 01/17/2020 09:45:49 AM

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:	LOPEZ FAMILY CHILD CARE		FACILITY NUMBER:	566213467
ADMINISTRATOR:	LOPEZ, NORMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 814-4630
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY:	14	CENSUS: 0	DATE:	01/17/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Norma Lopez		TIME COMPLETED:	09:45 AM

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On January 17, 2020 at 8:40 A.M. Licensing Program Analyst (LPA) Betzayra Cervantes and Licensing Program Manager (LPM) Mingle made an unannounced visit to conduct an Annual/Random inspection. LPA and LPM met with licensee Norma Lopez and discussed the nature and purpose of the visit. Together both licensee, LPA and LPM conducted a tour of the home inside and outside. There were no children in care when LPA and LPM arrived.

The licensee uses the play room, family room, dining room, one restroom, and front yard for the day care. LPA observed a safety gate at the base of the stairs leading to the second floor and safety gates placed on the two entries into the kitchen. Licensee states that there are no firearms and ammunition in the home. LPA did not observe toxins/hazards accessible to children in care. There are age appropriate toys and furniture readily accessible to children. Licensee states that the backyard is off limits to children in care. The front yard is fully enclosed with a fenced wall. Licensee has age appropriate toys and play structures in the front yard in good condition and free of hazards.

The home has working smoke and carbon monoxide detectors. A 2A10BC fire extinguisher was observed mounted on the kitchen cabinet with a service date of 01/13/2020. Licensee has a valid CPR/First Aid certificate with an expiration date of 05/11/2021. Licensee has all required forms posted for parent's to view. A sampling of children records were reviewed and found current and complete. Licensee has AB 1207 Mandated Reporter Training Certificate on file expiring on 03/08/2020. LPA discussed and provided licensee with a Safe Sleep and Effects of Lead Exposure brochures.

Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra Cervantes	TELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020

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: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 566213467
	VISIT DATE: 01/17/2020

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Incidental Medical Services (IMS) was discussed. Licensee states currently no children with IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra Cervantes	TELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020

LIC809 (FAS) - (06/04)

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