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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010514
Report Date: 08/16/2021
Date Signed: 08/16/2021 12:54:16 PM

Document Has Been Signed on 08/16/2021 12:54 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
198010514
ADMINISTRATOR:LOPEZ, IRMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 779-2671
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
08/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Irma Lopez, Licensee TIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required Annual inspection to the above facility on 08/16/2021 at 11:30 AM. LPA conducted COVID-19 Screening call prior to entry of home. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Irma Lopez, who guided the LPA on a tour of the facility. Also present was Licensee's Assistant who is cleared. There are two adults living in the home and all have criminal record clearance. There were two day care children present during today’s inspection. Licensee states that there are currently ten children enrolled. The children's roster was reviewed and is current. Per licensee, the facility’s hours of operation are 6am to 6pm, 5 days a week. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection.

This is a single story home which consists of four bedrooms and one bathroom, kitchen, living room, dining, back house, side covered patio, and backyard. Areas used by the children include the Living Room for napping, Bathroom 1, back house for day care activities, covered side patio, and backyard. Per Licensee, areas off limits to children and parents include all bedrooms, and Dining Room and Kitchen are only used for a walkway in order to access Main Care Areas and back yard for outdoor play. Per licensee, off limit areas are locked during operating hours, LPA observed doors to be locked.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed fans through out home. There is a working telephone maintained in the home. Upon entry of home, LPA observed Living Room area which Licensee states will be used for napping and isolation of sick children until they are picked up, LPA observed wooden cribs used for napping infants. At 11:32 AM, LPA observed side covered patio to have child size tables and chairs, refrigerator, and sink; per Licensee this area will be used for eating by children. At 11:33 AM, LPA observed back house that children will use for daycare space to have cubbies for children's
Report continues- Page 1 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198010514
VISIT DATE: 08/16/2021
NARRATIVE
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belongings, carpet, play kitchen, wooden toy shelves filled with art materials blocks, puzzles, and other age appropriate toys, free of loose and sharp parts. LPA observed electrical cover outlets all through the home. LPA heard a dog barking in off limits bedroom, per Licensee dog is kept in a crate in the room and does not play with daycare kids. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The Licensee states that there are no poisons in the home. LPA observed back laundry area to rear of off limits kitchen to have detergents and cleaning compounds on top of high shelf making it inaccessible to children in care. The Licensee does understand that poison must be locked with a key or combination lock. At 11:51 AM, LPA observed Bathroom 1, which children will use, located next to kitchen to be free of hazards and with adequate hand washing supplies. At 11:53 AM, LPA observed drawer where sharp knives are kept to be kept in off limits kitchen area, per Licensee children are never left alone in that area as it is only used as a walk way. LPA advised Licensee that although she states she has full visual supervision of children, she should put a child safety lock on this drawer.

Per licensee, the children will have access to backyard area for outdoor play, children have direct access to backyard through double doors in day care space. At 11:34 AM, LPA observed backyard has turf grass, an elevated garden bed, and adequate perimeter fencing through-out the yard. LPA observed large wooden structure with slides and swing to have turf grass cushioning, child size bikes, small plastic play structure, and other age appropriate toys free of loose and sharp parts available for the children in the backyard and all trees, shrubs, and plants are maintained.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises. Per licensee, they provide food for children in care.

The valve on the required 2A 10BC fire extinguisher indicates fully charged. At 11:33 AM, LPA attempted to test smoke and carbon monoxide detectors but none were available during today's inspection, this poses an immediate health and safety risk to children in care. Per Licensee, she was going through remodeling and is unsure where the smoke and carbon monoxide detectors are but will purchase one. First Aid kit is kept in the Day Care Space, At 11:35 AM, LPA requested proof of Pediatric First Aid/CPR, Licensee was unable to provide proof at time of inspection making this a potential health and safety risk to children in care. Licensee states that she has one but did not have it readily available at the time of inspection. Proof of immunization against Report continues- Page 2 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198010514
VISIT DATE: 08/16/2021
NARRATIVE
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influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training
—Mandated Reporter AB1207 Completed: March 24, 2020
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

The following were discussed:
Incidental Medical Services (IMS)
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

Licensee (or facility representative) 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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.



The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. A hard copy of A Child Care Provider’s Guide to Safe Sleep, PIN 20-24-CCP, and LIC 9227 was provided.
Report Continues Next Page - Page 3 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198010514
VISIT DATE: 08/16/2021
NARRATIVE
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LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/www.mandatedreporterca.com

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview was conducted and report was reviewed with the Licensee, Irma Lopez.

Report ends- Page 3 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 08/16/2021 12:54 PM - It Cannot Be Edited


Created By: Katrina Chicote On 08/16/2021 at 12:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198010514

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/18/2021
Section Cited
CCR
102417(g)(1

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102417 (g)(1) Operation of a Family Child Care Home
... The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
This regulation was not met as evidenced by:
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Licensee states she will provide photo proof via email of installed smoke detector to LPA by POC date, 08/18/2021.
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Based on observations and interviews, the Licensee did not have smoke detector during today's inspection. Licensee states smoke detector is not operating. This poses an immediate health and safety risk to children in care.
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Type A
08/18/2021
Section Cited
HSC1597.543

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1597.543 Health and Safety Code
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards of department.
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Licensee states she will provide photo proof via email of installed smoke detector to LPA by POC date, 08/18/2021.
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Based on observations and interviews, the Licensee did not have carbon monoxide detector during today's inspection. This poses an immediate health and safety risk to children in care.
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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:Trevino Cochran
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/16/2021 12:54 PM - It Cannot Be Edited


Created By: Katrina Chicote On 08/16/2021 at 12:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198010514

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/18/2021
Section Cited
CCR
102416(c)

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102416 (c) Personnel Records
The licensee...shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid,..
This regulation was not met as evidenced by:
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Licensee states she will provide photo proof of completion of pediatric first aid/CPR via email by POC date, 08/18/2021.
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Based on interviews and record review, the licensee did not have proof of pediatric first and CPR readily available during today's inspection. Licensee states she has current but does not have proof.
This poses a potential health, safety, or personal rights risk to children in care.
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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:Trevino Cochran
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2021


LIC809 (FAS) - (06/04)
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