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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216488
Report Date: 03/05/2024
Date Signed: 03/05/2024 02:08:19 PM

Document Has Been Signed on 03/05/2024 02:08 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:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
03/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:04 PM
MET WITH:Lucia Lopez JoseTIME COMPLETED:
02:15 PM
NARRATIVE
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On 3/5/24, Licensing Program Analysts (LPAs) Francisca Velazquez and Joaquin Mendez conducted an unannounced Case Management inspection of the Family Child Care Home (FCCH) for a change of capacity. LPAs met with, Maria Jose Vasquez, Assistant of the FCCH and explained the nature/purpose of the inspection. LPAs note there were five (5) children present during this inspection being cared by assistant. LPAs note, Licensee, Lucia Lopez Jose arrived about 3 minutes after the inspection started with one (1) additional child.

During this inspection, LPAs and Licensee together toured the interior and exterior of the FCCH. LPAs observed a fireplace in the living room that is secured and inaccessible to children in care. LPAs observed a gate in front of the kitchen that is not secured. At 12:26 PM, LPAs observed sharps are stored in a drawer in the kitchen that has a lock, but the lock does not function and therefore knives and lighters were accessible to children in care. Cleaning compounds were observed in the laundry room that was locked and secured. Medication for the family is also stored in the laundry room and was found to be inaccessible to children in care. At 12:31 PM, LPAs observed the bedroom that are identified as off-limits did not have a lock that was secured, making the bedrooms accessible to children in care.

LPAs reviewed the Licensee’s First Aid/ CPR certification which was completed on 4/9/22. Licensee’s Mandated Reporter Training certificate, which was completed on 9/15/22. Assistant First Aid/ CPR certification which was completed on 4/23/23. Licensee’s Mandated Reporter Training certificate, which was completed on 10/23/23. LPAs observed a regulation fire extinguisher which was serviced on 1/24/24. LPAs observed a combination smoke and carbon monoxide detector that was tested at 12:31 PM and was operable.

The Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 03/05/2024
NARRATIVE
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The Licensee is the owner of the home and provided proof of control of property. The Santa Maria Fire Department granted a fire clearance following an inspection completed at FCCH on 2/29/24.

Today, deficiency cited under Title 22 Division 12. Appeal rights given. Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report.

LPAs note that Licensee corrected the deficiencies prior to this inspection concluding. The gate in the kitchen has been tighten and is now secured. Additionally, the lock has been replaced on the kitchen drawer. Lastly, all off-limits bedrooms have their door safety knobs secured. LPAs note, all these areas are now inaccessible.

The home meets Title 22 of CCR requirements for a Large Family Child Care license effective today. Effective date of license is today 3/5/24. LPA provided the Licensee a Notice of Site Visit (LIC 9213) to be posted.



Exit interview and review of this report was conducted with licensee, Lucia Lopez Jose in Spanish.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
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Document Has Been Signed on 03/05/2024 02:08 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 03/05/2024 at 01:28 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LOPEZ JOSE FAMILY CHILD CARE
FACILITY NUMBER: 426216488

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/06/2024
Section Cited
CCR
102417(g)(4)

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(g)The home shall be free from defects or conditions which might endanger a child (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available... At 12:26pm, LPA observed knives are stored in a kitchen drawer with a lock that is not
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Licensee agrees to secured the gate and kitchen drawer to ensure these areas are inacessible to chidlren in care. Addtionally, Licensee agrees to ensure that all off limit areas have a secured barrier making the areas inacessible.
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secured and therefore knives and lighters are acessible to children in care. At 12:31pm, LPAs observed the off-limit bedrooms did not have a door safety knob to make the room inacessible and personal hygiene items were within children's reach. (colgones, hairspray, lotions, etc).
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 Licensee will sbumit picture/video evidence of these corrections by 3/6/24 to Francisca.Velazquez@dss.ca.gov

This POC was completed prior to the conclusion of this inspecion.

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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:Maria Mueller
LICENSING EVALUATOR NAME:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024


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