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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364813437
Report Date: 07/14/2023
Date Signed: 07/14/2023 06:14:44 PM

Document Has Been Signed on 07/14/2023 06:14 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: 4DATE:
07/14/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:09 PM
MET WITH:Jocelyn Roces-LopezTIME COMPLETED:
06:15 PM
NARRATIVE
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On this date and time, Licensing Program Analysts (LPAs) Laura Mejorado and Susan Brewer made an unannounced plan of corrections visit for citations issued during a previous inspection at the facility on 07/11/2023. LPAs met with Licensee Jocelyn Roces-Lopez, also present was Licensees husband, 4 daycare children and 2 additional adult residents with 1 resident child, renting the detached dwelling in the back of the home. LPAs toured the home inside and out, verified associations and discussed the following:

Licensee was cited on 07/11/23 for 102425(b) Infant Safe Sleep, 102370(d)(1) Criminal Record Clearance, 102423(a)(2) Personal Rights, 102416.2(a)(2) Reporting Requirements, 102416.1(d) Personnel Records, and 102416.5(f) Staffing Ratio and Capacity.

The citation for 102370(d)(1) Criminal Record Clearance has been cleared but fingerprint clearance is still pending for A1.

Plan of corrections were submitted for citations pertaining to 102425(b) Infant Safe Sleep, 102423(a)(2) Personal Rights, 102416.2(a)(2) Reporting Requirements and 102416.5(f) Staffing Ratio and Capacity. Plans of correction are currently under review.

A plan of correction is still pending for 102416.1(d) Personnel Records for Licensees assistant A2. A plan of correction extension has been granted until 7/21/23. Failure to correct may result in a civil penalty of $100 per violation per day until the violation is corrected.

LPAs were unable to verify facility records and Licensee was asked to submit the following records:
- TB test for all adults residing in the home and working in the home
- Updated LIC999 reflecting all on and off limits of the home, including the detached dwelling in the back of the home.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2023
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: 07/14/2023
NARRATIVE
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While at the facility LPA's observed an unclear adult (A3) in an additional dueling located in the backyard of the home. Licensee initially introduce A3 by another name on visit dated 7/11/23, during todays inspection Licensee admitted they gave a false name for A3 and admits A3 has not been fingerprinted. A3 has been residing on the facility property since 2020 without a fingerprint clearance. This poses an immediate health/safety, or personal rights risk to persons in care. SEE LIC809D for Type A Deficiency for 102370(d)(1) Criminal Record Clearance.

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 7/14/23 documents 1 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 7/14/23 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.

Exit interview conducted and report was reviewed with Licensee, Jocelyn Roces-Lopez.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/14/2023 06:14 PM - It Cannot Be Edited


Created By: Laura Mejorado On 07/14/2023 at 05:20 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
, 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: 07/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/17/2023
Section Cited
CCR
102370(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 A3 fingerprinted and submit proof to CCL by 7/17/23.
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Based on observation, interview and Licensees admission, A3 has not been fingerprinted and has been residing in the home since 2020, 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: 07/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2023


LIC809 (FAS) - (06/04)
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