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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216488
Report Date: 02/02/2023
Date Signed: 02/02/2023 01:41:24 PM

Document Has Been Signed on 02/02/2023 01:41 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 JOSE FAMILY CHILD CAREFACILITY NUMBER:
426216488
ADMINISTRATOR:LUCIA LOPEZ JOSEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 623-9368
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/02/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Lucia Lopez JoseTIME COMPLETED:
01:50 PM
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On 2/2/23 at 11:15 AM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Pre-licensing Inspection of the residence and met with Applicant, Lucia Lopez-Jose. LPA informed Applicant of the nature and purpose of the inspection. LPA notes there are no children present during this inspection. Applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 3AM to 11PM, Monday- Saturday. The Applicant also Informed LPA of the intention to provide care for children 0 months to 12 years of age. There are two (2) adults and two (2) minor children that live in the home and both adults have received criminal record clearance.

LPA toured the interior and exterior of the residence with the Applicant. This is a single story home that consists of three (3) bedrooms, two (2) bathrooms, living room, kitchen, dining room, laundry room, garage, and three outdoor yards (front yard, back yard and side yard). The home's living room, dinning room, one (1) bathroom, and three (3) outdoor yard will be used for childcare services, while the kitchen, three (3) bedrooms, one (1) bathroom, laundry room and garage are inaccessible to children in care. In the living room, LPA observed a fireplace that is made inaccessible by means of a safety latch. LPA observed the living room to have plenty of spacing and ventilation for children in care. LPA observed the kitchen is made inaccessible by means of a baby gate. LPA observed sharps are stored in a drawer in the kitchen that is locked. LPA observed cleaning compounds are stored in an elevated cabinet in the kitchen, laundry room and Applicant's bedroom, all areas are inaccessible to children in care. LPA observed medication in the home is stored in the Applicant's bedroom and in the laundry room, both areas are inaccessible to children in care. The bathroom of the residence is observed to be clean and free of toxins.

LPA observed a required fire extinguisher (2A10BC) in the home which was purchased on 9/25/22. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has a smoke and carbon monoxide detector which were tested at 12:05 PM and found to be operable.
CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2023
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: LOPEZ JOSE FAMILY CHILD CARE
FACILITY NUMBER: 426216488
VISIT DATE: 02/02/2023
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LPA and Applicant toured all three (3) outdoor yards. LPA observed the back yard to be completely fenced. LPA observed that part of the yard is made inaccessible by means of a fence. There is one (1) shed that is locked and in the part of the yard that is inaccessible to children. LPA observed the side yard to be completely fenced with grassing and cement area. Per Applicant, during the summer months a canopy will be added for additional shading. LPA observed the front yard to be completely fenced. There is a large tree that affords the front yard plenty of shading for the children. LPA and Applicant discussed active supervision especially when children are in the front yard. Applicant reported that children will always be supervised when playing in any of the outdoor yards. Filtered water will be accessible to children by means of individual water bottles. LPA observed all toys, equipment and supplies used for children are age appropriate.

LPA's record review revealed Applicant completed Preventative Health training on 10/21/22. Further, Applicant completed Mandated Reporter training on 9/15/22 and Pediatric CPR/First Aid (EMSA approved) on 4/9/22 . LPA reminded Applicant of obligation to maintain current training and certifications. LPA reviewed Applicant's control of property document (mortgage deed). Applicant does not have liability insurance for the home as of yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282). Applicant was unable to provided proof of one (1) year experience working in a child care setting, therefore, Applicant will be granted a Small FCCH. Per Applicant, there are no guns or ammo in the home.



LPA reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with Applicant 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 Applicant 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. CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
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 JOSE FAMILY CHILD CARE
FACILITY NUMBER: 426216488
VISIT DATE: 02/02/2023
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicant, Lucia Lopez-Jose. The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license will be noted as the present, 2/2/23.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC809 (FAS) - (06/04)
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