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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354416067
Report Date: 04/16/2024
Date Signed: 04/16/2024 03:56:16 PM

Document Has Been Signed on 04/16/2024 03:56 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, VANESSAFACILITY NUMBER:
354416067
ADMINISTRATOR/
DIRECTOR:		VANESSA LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 537-5730
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 2DATE:
04/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Vanessa LopezTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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Licensing Program Analysts (LPAs), Cortney Nelson and Andrea Cortez, met with the Licensee, Vanessa Lopez, to conduct follow-up regarding changes to the on/off limits areas of the home. Upon arrival, LPAs were admitted into the home by the licensee and toured the entire inside and outside of the home.

Inside of the home, the Licensee is planning to add the kitchen and second living room to the on-limits areas of the home. Off-limits inside of the home include: three (3) bedrooms, one bathroom, attached garage, and renter unit/bathroom. LPAs advised that aluminum foil and plastic wrap in the kitchen shall be moved to be inaccessible to children. The Licensee moved the items to the kitchen cabinets during today's inspection. The second living room has a large rock fireplace that LPAs advised that be barricaded to be inaccessible to children. There is a fireplace screen in front of the opening of the fireplace, however due to the large rock structures attached to the fireplace, LPAs advised barricading further for safety reasons. The Licensee states she will barricade the fireplace. LPAs additionally advised that electrical outlets in the second living room need covers over the outlets as they are currently open. The Licensee states that she plans to use the second living room for children's napping and watching movies and anticipates adding cots to the space. There are no other play equipment or other items in the second living room, they are all located in the current on-limits living room area.

Outside of the home, the Licensee will be using the back yard for the day care and the side yard will be off-limits. LPAs observed that the side yard area of the home is completely fenced off and the renter has play equipment for her son in the area. The renter stated that the area is not used for day care and is only for her child that resides in the rental unit. Off-limits outside of the home include the side yard and the shed.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LOPEZ, VANESSA
FACILITY NUMBER: 354416067
VISIT DATE: 04/16/2024
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LPAs observed that the backyard area is equipped with plastic play equipment, shelves full of children's toys, a basketball hoop, grass area, and deck attached to the home. The Licensee has two large dogs and LPAs advised that the grass area shall be checked daily as dog feces was observed throughout the grass area to the left of the deck. The Licensee additionally has rosebushes that are accessible to the children. LPAs advised that the rosebushes shall be fenced to block accessibility by the day care children as the fence currently in front of the rosebushes is too short to stop children from touching it. The Licensee inquired if she can use the garden area at the top of the outside area for the day care children and LPAs advised that it may be used, however because the entire backyard area is not fenced in, the day care children shall be under constant visual supervision at all times. The Licensee states that she is not using the backyard area for the day care children, however LPA Nelson inquired with a child in care if he plays in the backyard and he stated yes, LPA asked if he played in the backyard today and the child again stated yes.

LPAs additionally advised that a revised fire clearance will be requested for the day care home due to the changes in the on/off limits of the home. LPAs advised that the changes to the on/off limits areas of inside and outside of the home shall not be used until approved by the Department, on-going investigations are completed, and the fire clearance is approved/updated by the fire department.

LPAs informed licensee (Vanessa Lopez) that this report dated (4/16/2024) documents one Type A citation, which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs informed the licensee to provide a copy of this licensing report dated (4/16/2024) that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

As a result of today's inspection, a deficiency was cited, see LIC809-D.

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

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/16/2024 03:56 PM - It Cannot Be Edited


Created By: Cortney Nelson On 04/16/2024 at 03:10 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LOPEZ, VANESSA
FACILITY NUMBER: 354416067

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/17/2024
Section Cited
CCR
102417(b)

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102417 Operation of a Family Child Care Home (b) The home shall be kept clean and orderly..

This requirement was not met as evidenced by:
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The Licensee shall discontinue use of the backyard area and clean the grass area of all dog feces. The grass shall be rinsed off by hose once dog feces removed. The rosebushes shall be fenced to be made inaccessible to children in care.
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The License did not ensure that the home is kept clean and orderly as mulitple dog feces were observed in the backyard grass area and approximately six (6) rosebush plants were accessible to children, which poses an immediate risk to the health, safety, and personal rights of children in care.
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The Licensee shall submit photos to the Department by end of day 4/17/2024 showing dog feces removed from grass. The rose bushes to be fenced and inaccessible by 4/22/2024 and pictures to be submitted.

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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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024


LIC809 (FAS) - (06/04)
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