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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376622201
Report Date: 11/07/2024
Date Signed: 11/07/2024 04:27:24 PM

Document Has Been Signed on 11/07/2024 04:27 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:LOPEZ, ANGELICA FAMILY CHILD CAREFACILITY NUMBER:
376622201
ADMINISTRATOR/
DIRECTOR:		ANGELICA LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 436-8125
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
11/07/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Angelica LopezTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
NARRATIVE
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On 11/07/2024 Licensing Program Analyst (LPA), Dana Stevens conducted an unannounced Annual Random Inspection. Upon arrival, LPA was greeted by Licensee's assistant, Rebecca Dominguez. LPA disclosed the purpose of the inspection and was granted entry into the facility. Licensee's additional assistant, Maria Perez was also present in the facility with 11 napping daycare children. Licensee, Angelica Lopez, was not present at the time of LPA's entry into the facility, however, after assistant notified her by phone of LPA's presence, returned to the facility about 10 minutes after LPA's arrival.

Licensee stated she currently has 14 children enrolled. Licensee accompanied LPA throughout the inspection of this 3 bedroom, 2 bathroom home. The following areas are used for child care: living room and hall bathroom. Off Limit areas include: the remainder of the house (kitchen, laundry room, all bedrooms, master bath and garage). These areas are made inaccessible with safety gates and doorknob covers. The Licensee is utilizing the backyard for outdoor activities of children and Licensee stated total supervision is provided.

The fire extinguisher and combination smoke/carbon dioxide detector met requirements.  The licensee has toys, play equipment and materials available. A review of records on this date indicates that all individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee's First Aid and CPR certifications are current and expire 10/2026. Assistant Dominguez's First Aid and CPR certifications are current and expire 08/2025. Licensee renewed Mandated Reporter Training 10/2024. Assistant Dominguez completed Mandated Reporter training 08/2023. Assistant Perez completed Mandated Reporter training 10/2024. Facility roster and a sample of children's files were reviewed. Infant sleep plans and logs were missing from Infant files. The last fire drill was conducted and documented in 07/2024.

SUPERVISORS NAME: Cynthia Biszant
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: LOPEZ, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 376622201
VISIT DATE: 11/07/2024
NARRATIVE
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.


Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

Exit interview conducted and copy of report and appeal rights were provided to the licensee and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days

SUPERVISORS NAME: Cynthia Biszant
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 11/07/2024 04:27 PM - It Cannot Be Edited


Created By: Dana Stevens On 11/07/2024 at 03:42 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: LOPEZ, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 376622201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above by allowing blankets to be in the crib while an infant is sleeping, which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 12/09/2024
Plan of Correction
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Licensee will review the safe sleep regulations on the CCLD webpage (link to webpage provided in this report) and provide a written plan to LPA via email or mail of how she will ensure all infants (2 years and younger) will be provided safe sleep environments while in care.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in by not having proof of MMR immunization in assistant's file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/09/2024
Plan of Correction
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Licensee will provide proof of MMR immunization for her assistant to LPA via email or mail.
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:Cynthia Biszant
LICENSING EVALUATOR NAME:Dana Stevens
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 11/07/2024 04:27 PM - It Cannot Be Edited


Created By: Dana Stevens On 11/07/2024 at 03:42 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: LOPEZ, ANGELICA FAMILY CHILD CARE
FACILITY NUMBER: 376622201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2024

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 record review the licensee did not comply with the section cited above by not having Individual Infant Sleep Plans (LIC9227) for infants in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/09/2024
Plan of Correction
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Licensee will provide copies of Individual Infant Sleep Plans in for all infants in care to LPA via email or mail.
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by not maintaining current sleep logs for all infants (2 years and younger) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/09/2024
Plan of Correction
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Licensee will provide copies of completed sleep logs for all infants in care for the month of November 2024 via email or mail.
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:Cynthia Biszant
LICENSING EVALUATOR NAME:Dana Stevens
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2024


LIC809 (FAS) - (06/04)
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