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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014941
Report Date: 07/07/2022
Date Signed: 07/07/2022 04:17:30 PM

Document Has Been Signed on 07/07/2022 04:17 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
198014941
ADMINISTRATOR:AURORA LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 470-9974
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:14 PM
MET WITH:Aurora Lopez, LicenseeTIME COMPLETED:
05:00 PM
NARRATIVE
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On 07/07/22, Licensing Program Analyst (LPA) Liana Stepanyan conducted an unannounced comprehensive annual random site visit to ensure the health & safety standards as required by regulations governing family childcare homes. LPA met with licensee, also present was helper Salvador Lopez and 4-day care children. Licensee has all appropriate forms posted. First Aid/CPR certificate is valid thru 02/24. LPA confirmed with licensee that all adults residing/working in the home have criminal record/TB clearances. Licensee has practiced fire/emergency drills with daycare children on 06/14/22.

This 1 story, 3-bed, 1-bath home was toured, the following areas are used for daycare: living/dining/family room, hallway bathroom, kitchen and backyard. Off limit areas include: all bedrooms, garage and laundry room. Drawers and lower cabinets in kitchen/bathroom are either latched or do not contain any hazardous items. There is an non-operational smoke alarm in the home. The home has electrical outlet covers throughout and maintains a First Aid Kit in the kitchen area. There are adequate age appropriate toys, books, games, and napping mats/hygienic diaper changing equipment. There are no firearms present on the premises as stated by licensee. Furthermore, there are no bodies of water. The outdoor play area is a fenced backyard, which is free of hazards and has sufficient toys. There is a pet dog present in the home which is kept in off-limit area during daycare hours. Per licensee, operating hours are from 7am-9pm, Monday thru Saturday.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Liana Stepanyan
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2022
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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Document Has Been Signed on 07/07/2022 04:17 PM - It Cannot Be Edited


Created By: Liana Stepanyan On 07/07/2022 at 03:27 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198014941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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NA
POC Due Date: 07/21/2022
Plan of Correction
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NA
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation,interview, record review, the licensee did not comply with the section cited, LPA did not observe a log documenting infant 15 minutes checks for child #1 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2022
Plan of Correction
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Licensee will get a template from CCRC to start documenting 15 minute check with infants.
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:Mariela Ramon
LICENSING EVALUATOR NAME:Liana Stepanyan
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/07/2022 04:17 PM - It Cannot Be Edited


Created By: Liana Stepanyan On 07/07/2022 at 03:27 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198014941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above, LPA did not observe an LIC 9227 form filled out for child #1 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2022
Plan of Correction
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Licensee will have parent fill out the form and place it in the child's file. Licensee will email proof to LPA by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mariela Ramon
LICENSING EVALUATOR NAME:Liana Stepanyan
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022


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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198014941
VISIT DATE: 07/07/2022
NARRATIVE
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LPA reviewed the following: required departmental documents, regulation highlights, community resources, capacity limitations, supervision, clearances, emergency drills, heat-related illness, child passenger law, unusual incidents, mandated reporting, SIDS, Shaken Baby Syndrome, and Megan's law. Applicant is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation.

For licensing regulations/updates/forms, go to webpage http://www.ccld.ca.gov

There were items found in non-compliance per CCR, Title 22, Division 12, Chapter 3; see deficiencies cited on LIC809D. Discussed appeal rights with licensee. Be aware that Notice of Site Visit must be posted for 30 days.

An exit interview is conducted, copy of the report was provide to licensee along with appeal rights and notice of site visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Liana Stepanyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 07/07/2022 04:17 PM - It Cannot Be Edited


Created By: Liana Stepanyan On 07/07/2022 at 04:08 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 198014941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on oberservation the licensee did not comply with the section cited above, LPA did not observe an operating smoke alarm inside the facility which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2022
Plan of Correction
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Licensee will replace the batteries and send a video via email to LPA by POC due date
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mariela Ramon
LICENSING EVALUATOR NAME:Liana Stepanyan
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022


LIC809 (FAS) - (06/04)
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