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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274416060
Report Date: 03/11/2024
Date Signed: 03/11/2024 12:07:41 PM

Document Has Been Signed on 03/11/2024 12:07 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LOPEZ, JAQUELINEFACILITY NUMBER:
274416060
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
03/11/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Jaqueline Lopez TIME COMPLETED:
12:00 PM
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
Licensing Program Analyst (LPA), Elizabeth Larios, met with Licensee, Jaqueline Lopez, to conduct case management visit for capacity increase to a large family child care home (FCCH). Upon arrival, LPA was admitted into the home by Irene and toured both indoors and outdoors during today's inspection.

Fire clearance was approved for the home by King City Fire Marshal's Office/Carmel Fire Protection on 1/30/2024. The Licensee states that adults, over the age of 18, residing in the home is herself and spouse. Off-limits inside the home include: master bedroom/bathroom, bedrooms 1 & 2, laundry room, and garage. All other areas in the home will remain on-limits and unchanged from the small family child care home limitations. The home is equipped with a 2A10BC fire extinguisher (last serviced 12/18/2023) functioning smoke detector and carbon monoxide detector. The last emergency disaster drill was conducted on 03/05/2024. There are sufficient toys and materials that are age-appropriate and safe for children.

LPA toured outside of the home and observed it is fenced in for children. Off-limits outside of the home include: left side of yard and the right side of house. Shade is provided for the children by hardtop gazebo and outside the children have plastic play structures to play with. LPA observed a fish tank located in the living room that is at least five (5) feet high and the body of water is inaccessible to children. LPA observed a cover on the top of the fish tank, however the tank is high enough off the ground that children cannot access or reach the top of the tank. Licensee has a dog that is fully vaccinated and kept in off limit areas.

LPA reviewed large FCCH capacity with the Licensee, Jaqueline Lopez, and she understands that whenever an assistant is not present, she shall follow capacity requirements for a small FCCH. LPA advised that a large FCCH may care for more than 12 children and up to and including 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age. LPA provided the Licensee with large FCCH capacity reference sheet as well as copy of Section 102416.5 Staffing Ratio and Capacity.


====CONTINUE ON LIC 808-C====
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2024
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LOPEZ, JAQUELINE
FACILITY NUMBER: 274416060
VISIT DATE: 03/11/2024
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 advised that an assistant must be older than 14 years old and shall have all required documentation on file such as proof of immunization's (MMR, Tdap, flu), negative tuberculosis (TB) test, Mandated Reporter training for child care providers, and all Licensing paperwork in file.

If an assistant is older than 18 years old, the assistant must receive Criminal Record Clearance through DOJ, FBI, and CACI within 30 days of turning 18. LPA additionally advised an assistant under the age of 18 shall not be left alone with day care children at any time. LPA advised an assistant over the age of 18 shall remain alone with the children, however must have proof of pediatric First-Aid/CPR. Jaqueline states she will not be transport children.

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

LPA advised that a license for a large FCCH will be issued following manager review and approval.

A NOTICE OF SITE VISIT HAS BEEN GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2