<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215566
Report Date: 02/11/2020
Date Signed: 02/11/2020 10:25:26 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:LUPIAN FCC AKA TIA CLEO DAYCAREFACILITY NUMBER:
566215566
ADMINISTRATOR:CLEOPATRA LUPIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 278-9849
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY:14CENSUS: 8DATE:
02/11/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Cleopatra LupianTIME COMPLETED:
10:30 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 February 11, 2020 at 8:45 A.M. Licensing Program Analyst (LPA) Betzayra Cervantes made an unannounced visit to conduct an Annual/Random inspection. LPA met with licensee Cleopatra Lupian and discussed the nature and purpose of the visit. Together both licensee and LPA conducted a tour of the home inside and outside. Licensee and her assistant were caring for eight children when LPA arrived.

The licensee uses the living room, kitchen, two bedrooms, one bathroom, and backyard for the day-care. There are no bodies of water in the home. Licensee states that there are no firearms and ammunition in the home. LPA did not observe toxins/hazards accessible to children in care. Licensee has a safety gate in the hallway making the three bedrooms and one bathroom inaccessible to children. There are age appropriate toys and furniture readily accessible to children. The backyard is fully enclosed with a fenced wall. LPA observed a locked storage shed in the backyard making it inaccessible to children in care. Licensee has age appropriate toys and play structures in the backyard in good condition and free of hazards.

The home has a working smoke and carbon monoxide detector. A 2A10BC fire extinguisher was observed in the hallway closet with a service date of 8/22/2019. LPA verified that the licensee and assistant are current with SB 792 immunization requirements. Licensee has a valid CPR/First Aid certificate with an expiration date of 04/11/2021. 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. The last fire drill was conducted on 01/20/2020. 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. Continued on 809-C

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra CervantesTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
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 2
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: LUPIAN FCC AKA TIA CLEO DAYCARE
FACILITY NUMBER: 566215566
VISIT DATE: 02/11/2020
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
LPA discussed and provided licensee with a Effects of Lead Exposure and "What Does a Safe Sleep Environment Look Like" brochures.

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. Today's visit was conducted in Spanish.



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 MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra CervantesTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2