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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004876
Report Date: 05/11/2022
Date Signed: 05/11/2022 10:47:25 AM

Document Has Been Signed on 05/11/2022 10:47 AM - 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:LOPEZ GUZMAN, DAISY N.FACILITY NUMBER:
414004876
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/11/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Daisy Lopez GuzmanTIME COMPLETED:
11:00 AM
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On 5/11/2022 at 9:50A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Applicant, Daisy Lopez Guzman. Purpose of the inspection was explained and was an announced follow-up, prelicensing inspection, to review corrections established on 3/28/2022. Present during inspection was the applicant and no children. Per applicant, her parents are temporarily visiting from abroad. Day-care Areas are: Living Room (Napping Area), Garage Area #1 (Playroom), Bathroom #1 and the Outdoor Play Area. Off-limit Area are: Bedroom #1, Bedroom #2, Bedroom #3, Bathroom #2, Garage Area #2, Garage Area #3/ Studio Unit, Kitchen, Dining Area and Laundry Area. LPA inspected facility with licensee for health and safety hazards.

At 9:55A.M., the following was observed: Required forms have been posted in entry way, and visible postings included: LIC610A, PUB 394 and LIC9148. Garage #1 (Playroom) was reviewed during inspection. Per licensee, napping services will take place in living room area only. LPA reminded licensee to ensure all infant cribs are equipped with properly sized mattresses and with tight-fitting/ adjustable sheets. One cribs must also be available for each infant child in care.

At 10:00A.M,. LPA inspected the outdoor play area. Outdoor playthings inspected were in good repair. Area was free of potential hazards. Plants and shrubs with exposed thorns have been removed.

During today’s inspection, licensee submitted their updated mandated reporter training certification, expiring on 3/8/2024.

As of 5/11/2022, all adults living in the home have received criminal record clearance eligibility.

On 5/11/2022, Applicant will be recommended for approval of family childcare home licensure.

Copy of the report was reviewed with provider. This report will be kept with the facility files and made available upon request.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2022
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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