566213467-4-20-2022-17-CC-BCES-CDNP54-20220420110008

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566213467
Report Date: 04/20/2022
Date Signed: 04/20/2022 11:00:20 AM

Document Has Been Signed on 04/20/2022 11:00 AM - It Cannot Be Edited

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: 7	DATE:	04/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Norma Lopez		TIME COMPLETED:	11:15 AM

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 April 20, 2022 at 9:35AM, Licensing Program Analyst (LPA) Betzayra Cervantes conducted an unannounced visit to conduct a Required - 1 Year inspection. LPA spoke to licensee Norma Lopez and conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA discussed the nature and purpose of the inspection. Licensee and LPA toured the facility inside and outside. Fingerprint cleared adult was also present during the inspection. There were seven children in care at the time of the inspection.

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 making it inaccessible to children in care. There are age appropriate toys, teaching materials and furnishings in good condition and free of hazards. The four bedrooms and four bathrooms are off limits and are inaccessible to children in care. Licensee has age appropriate toys and play structures in the front yard in good condition and free of hazards. LPA did not observe any toxins/hazardous items accessible to children. Licensee has two dogs which are kept in a separate fenced area of the backyard which is secured and inaccessible to children.

All adults in the home are fingerprint cleared. LPA did not observe any toxins/hazardous items accessible to children. A regulation 2A10BC fire extinguisher was observed with a service date of 01/04/2022. Licensee is reminded to service or purchase the fire extinguisher yearly. LPA observed licensee's assistant test the smoke and carbon monoxide detectors in the home which were found operational. LPA observed the home to be orderly. No bodies of water were observed on site. No toxins nor hazards are accessible to children in care. Detergents and cleaning compounds are stored out of reach of children. The bathroom to be used for children in care was observed to be clean and sanitary.

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: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: 04/20/2022

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
26
27
28
29
30
31
32

Licensee's Pediatric First Aid/CPR certificate is valid until 03/22/2023. Licensee's Mandated Reported Training certificate is valid until 10/30/2022. Licensee last completed an earthquake drill on 2/3/2022. Licensee states that there are no firearms and ammunition in the home. During file review at 10:15AM, LPA observed that licensee did not have a child file for Child #7. Licensee stated that today was C7's first day at the daycare and the parent stated that they would provide paperwork at the end of the day during pickup.

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.

One Type B deficiency cited during this visit (see LIC 809-D). A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed in Spanish with the licensee, Norma Lopez.

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: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 04/20/2022 11:00 AM - 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 566213467
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in which Child #7 did not have a child file with the required state forms available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/29/2022
	Plan of Correction
1 2 3 4	Licensee will have Child #7's parent/authorized representative complete the required state forms prior to continung at the daycare facility. Licensee will submit proof to LPA Cervantes via email to betzayra.upchurch@dss.ca.gov by 4/29/22.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra Cervantes	TELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3