566214359-4-21-2022-17-CC-BCES-CDPSNT-20220421140205

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566214359
Report Date: 04/21/2022
Date Signed: 04/21/2022 02:02:15 PM

Document Has Been Signed on 04/21/2022 02:02 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	LOPEZ FAMILY CHILD CARE		FACILITY NUMBER:	566214359
ADMINISTRATOR:	GLORIA LOPEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 612-7863
CITY:	OXNARD	STATE: CA	ZIP CODE:	93035
CAPACITY:	14	CENSUS: 4	DATE:	04/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Gloria Lopez		TIME COMPLETED:	02:15 PM

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On April 21, 2022 at 12:10PM, Licensing Program Analyst (LPA) Betzayra Cervantes conducted an unannounced visit to conduct a Required - 1 Year inspection. LPA spoke to licensee's assistant Perla Massiel Mejia Aguilar and conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. Licensee was away on an errand and joined the inspection at 1:03 PM. Assistant present has a valid CPR/First Aid certificate with an expiration date of 06/22/2022. LPA discussed the nature and purpose of the inspection. Assistant and LPA toured the facility inside and outside. There were four children in care at the time of the inspection.

The home is a four bedroom, two and a half bath two story home. The licensee uses the family room which is used as the main play room, living room, dining room, one restroom, and backyard for the day care. LPA observed a safety gate at the base of the stairs leading to the second floor. The second floor is not used for day-care and is off limits to children. LPA observed a screen fireplace in the family room which is inaccessible to children. LPA observed age appropriate toys, teaching materials and furnishings in good condition and free of hazards. Licensee has a secured fence in the backyard and age appropriate toys for children in care, found in good condition and free of hazards. LPA observed a full size trampoline in the backyard with a child safety net around it. Licensee was advised to stay within the manufacturers requirements for the trampoline. LPA advised licensee that she must provide visual supervision at all times while the children are playing outside in the trampoline. LPA observed a storage shed in the backyard made inaccessible with a key lock. 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 mounted in the kitchen with a service date of 05/03/2021. Licensee is reminded to service or purchase the fire extinguisher yearly. Licensee states that there are no firearms and ammunition in the home.

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. LPA was able to test the carbon monoxide detector, but was unable to test the smoke alarm detector because the children were napping.

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: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

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: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 566214359
	VISIT DATE: 04/21/2022

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Licensee's Pediatric CPR and Fist Aid certification expires on 05/23/2022. AB 1207 Mandated Reporter Training certificate expires on 09/08/22. Licensee last completed an emergency disaster drill on 02/02/2022. All required forms including Notification Of Parent's Rights are prominently posted for parent's or authorized representatives to view. A roster of children in care was observed current and complete. A sampling of children records were reviewed and LPA observed Identification and Emergency Notification forms (LIC 700) and a copy of immunization records on file.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: 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.

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: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

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: 566214359
	VISIT DATE: 04/21/2022

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No deficiencies cited today. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Gloria 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: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

LIC809 (FAS) - (06/04)

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