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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364813437
Report Date: 07/11/2023
Date Signed: 07/11/2023 05:13:32 PM

Document Has Been Signed on 07/11/2023 05:13 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:ROCES-LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
364813437
ADMINISTRATOR:ROCES-LOPEZ, JOCELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 283-4195
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 15DATE:
07/11/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Jocelyn Roces-LopezTIME COMPLETED:
05:15 PM
NARRATIVE
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On this date and time, Licensing Program Analysts (LPA's) Laura Mejorado and Susan Brewer arrived at the facility to conduct an inspection regarding a separate matter. LPA's met with Licensee Jocelyn Roces-Lopez, also present was Licensee's assistant Maria Sibuea. LPA's toured the facility, verified associations, and took census. The following was discussed:

102425(b) Infant Safe Sleep
Upon entry LPA's observed an infant sleeping in a pack n play, the pack n play had a blanket hanging on its side covering the side and a blanket laying on top of it covering the top, inside the pack n play were three pillows. LPA's addressed the infant safe sleep violations and Licensee immediately removed the blankets and pillows as the infant continued sleeping. Licensee was previously advised of this regulation on a prior inspection on 11/17/22. This poses an immediate health/safety, or personal rights risk to persons in care. SEE LIC809D for Type A Deficiency
102370(d)(1) Criminal Record Clearance
While touring the facility LPA's were made aware of an adult family member (A1) who has been residing in the home since October 2022. A1 is residing in a room adjacent to the garage and den. Upon verifying associations, A1 was not associated to the facility. While conducting interview, Licensee disclosed A1 has never been fingerprinted. This poses an immediate health/safety, or personal rights risk to persons in care. SEE LIC809D for Type A Deficiency
102423(a)(2) Personal Rights
While touring the facility LPA's found a daycare child in an off limits area of the home. Daycare child was forced into an off limit area of the home where an associated adult resident of the home resided. Daycare child was taken to the off limits room to wait while licensing conducted their inspection. Interviews with pertinent parties disclosed the daycare child did not know what was going on and contacted their parent. This poses an immediate health/safety, or personal rights risk to persons in care. SEE LIC809D for Type A Deficiency
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: ROCES-LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 364813437
VISIT DATE: 07/11/2023
NARRATIVE
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102416.2(a)(2) Reporting Requirements
While conducting interviews Licensee disclosed A1 had moved into the home in October 2022 and Licensee did not inform the Department nor update their forms. This poses a potential health/safety, or personal rights risk to persons in care. SEE LIC809D for Type B Deficiency.

102416.1(d) Personnel Records
While conducting file reviews Licensee was unable to provide a file for assistant Maria Sibuea. This poses a potential health/safety, or personal rights risk to persons in care. SEE LIC809D for Type B Deficiency.

See LIC809D for cited deficiencies of the California Code of Regulations, Title 22.

Civil penalties were assessed during todays inspection.

If a Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

LPA's Mejorado and Brewer informed licensee Jocelyn Roces-Lopez that this report dated 7/11/23 documents 3 Type A citations which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Also, LPA's Mejorado and Brewer informed the licensee Jocelyn Roces-Lopez to provide a copy of this licensing report dated 7/11/23 that documents any Type A citation(s) 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.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 07/11/2023 05:13 PM - It Cannot Be Edited


Created By: Laura Mejorado On 07/11/2023 at 02:33 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: ROCES-LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 364813437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/12/2023
Section Cited
CCR
102425(b)

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102425(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidence by:
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Immediately, Licensee agrees to follow the infant safe sleep regulations and maintain cribs free of any loos articles. Licensee agrees to submit a detailed written statement of their understandment of the safe sleep regulations and how they will maintain compliance.
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Based on observation, LPAs observed a sleeping infant in a pack n play with blankets covering the side and top and three pillows inside, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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Proof must be provided to CCL by 7/12/23.

Licensee was previously advised of this requirment on 11/17/22.
Type A
07/12/2023
Section Cited
CCR102370(d)(1)

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(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption...
This requirement is not met as evidence by:
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Immediatley, Licensee agrees to have A1 fingerprinted and submit proof to CCL by 7/12/23.
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Based on observation and interview, A1 moved into the home in October 2022 and did not obtain a fingerprint clearance, which
poses an immediate Health, Safety, or
Personal Rights risk to persons 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:Kimberly Williams
LICENSING EVALUATOR NAME:Laura Mejorado
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 07/11/2023 05:13 PM - It Cannot Be Edited


Created By: Laura Mejorado On 07/11/2023 at 03:08 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: ROCES-LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 364813437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/12/2023
Section Cited
CCR
102423(a)(2)

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(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged...(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
This requirement is not met as evidence by:
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Licensee agrees to submit a detailed statment on how childrens personal rights will be maintained. Licensee agrees to submit proof to CCL by 7/12/23.
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Based on observation and interview, LPAs observed a daycare child in an off limits area, child was forced into the off limit area while LPAs conducted their inspection and child did not know what was going on and contacted their parent, which poses a potential Health, Safety, or Personal Rights risk to persons 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:Kimberly Williams
LICENSING EVALUATOR NAME:Laura Mejorado
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 07/11/2023 05:13 PM - It Cannot Be Edited


Created By: Laura Mejorado On 07/11/2023 at 03:12 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: ROCES-LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 364813437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2023
Section Cited
CCR
102416.2(a)(2)

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(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day...(2) Any change in household composition including adults moving in or out of the home...
This requirement is not met as evidence by:
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Licensee agrees to submit a written statment acknowledging the importance of informing CCL of all adults residing in the home, along with an updated Application (LIC279) listing all adults residing in the home to CCL by 7/14/23.
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Based on interview, Licensee admitted A1 moved into the home in October 2022 and the department was not notified, which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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Type B
07/14/2023
Section Cited
CCR102416.1(d)

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(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement is not met as evidence by:
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Licensee agrees to obtain records for assistant and submit proof to CCL by 7/14/23.
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Based on record review, Licensee was unable to provide a file for their assistant, which poses a potential Health, Safety, or Personal Rights risk to persons 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:Kimberly Williams
LICENSING EVALUATOR NAME:Laura Mejorado
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023


LIC809 (FAS) - (06/04)
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