426216434-10-3-2022-17-CC-MJIZ-CJUREA-20221003125713

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216434
Report Date: 10/03/2022
Date Signed: 10/03/2022 12:57:28 PM

Document Has Been Signed on 10/03/2022 12:57 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	LOPEZ FAMILY CHILD CARE		FACILITY NUMBER:	426216434
ADMINISTRATOR:	MARIA LOPEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 266-4520
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 11	CENSUS: 0	DATE:	10/03/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Maria Lopez		TIME COMPLETED:	01:15 PM

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This is a change of location, previous facility number 426216120.

Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

On 10/3/2022, 10:55AM, Licensing Program Analyst (LPA) Martina Jimenez conducted an announced change of location, Pre-licensing inspection. LPA met with Maria Lopez, Licensee, the purpose of the visit was discussed and together with the licensee toured the inside and outside of the home. There were no children in care at the time of the inspection.

Licensee requested a change of location for a large family child care license and a Fire Clearance was granted on 9/25/2022. The home is a four (4) bedroom, four (4) bath, two (2) story home with an attached garage. The day-care areas are the living room, kitchen, dining room, day-care room, hallway bathroom, and backyard.

The three (3) bedrooms and two (2) bathrooms upstairs, along with detached garage were observed to be secured with door knob covers and safety gates at the bottom of the stairs, making the off-limits areas inaccessible to children in care.

CONTINUES 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 426216434
	VISIT DATE: 10/03/2022

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LPA observed the downstairs bedroom, kitchen, and attached garage, secured with locks and door knob covers, making these areas inaccessible to children.

LPA observed that knives are stores in a high cabinet inaccessible to children. There are age appropriate toys and napping equipment on the premises. Knives are stored out children’s reach, inaccessible to children. LPA observed child size furniture and material for activities.

LPA observed the home to be orderly. No toxins nor hazards are accessible to children in care. Detergents and cleaning compounds are stored out of reach of children. The bathroom to be used for children in care was observed to be clean and sanitary. The back yard is completely fenced and has age appropriate toys.

There will be two (2) adults living in the home. All adults have been fingerprint cleared.

LPA observed a regulation 2A10BC fire extinguisher in the kitchen that was purchased on 6/9/2022. Licensee is reminded to service or purchase the fire extinguisher yearly. The carbon monoxide detector and smoke detector were tested at 11:14am, and function at the time of inspection.

No bodies of water were observed. Licensee stated she does not hold a foster family license. Licensee is current with immunization required per SB 792. Per licensee, there are guns and ammunition in a locked safe. At 12:54pm, LPA observed that the guns and ammunition to be secured separately. First Aid and emergency kits are available.

Licensee has current Pediatric First Aid and CPR which expires, October 15, 2023. Licensee completed the Mandated Reporter Training on February 8, 2021. Control of property was verified via review of Deed of Trust.

LPA discussed Incidental Medical Services with the licensee. Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the

CONTINUES ON LIC 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 426216434
	VISIT DATE: 10/03/2022

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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: htttp://www.ada.gov/childqanda.htm

LPA reviewed and provided the handout "A Child Care Provider's Guide to Safe Sleep" (PIN 20-24-CCP), Effects of Lead Exposure, and What is Carbon Monoxide, LPA provided a Handout for Reporting Child Abuse and Neglect Training provided online at www.ccld.ca.gov.

Applicant was made aware the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

The home meets Title 22 Division 12 requirements of a Large FCCH license. Effective date of license will be noted as 10/3/2022.

No deficiencies cited during this visit. THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC809 (FAS) - (06/04)

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