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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216593
Report Date: 05/15/2023
Date Signed: 05/15/2023 04:38:43 PM

Document Has Been Signed on 05/15/2023 04:38 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 CAREFACILITY NUMBER:
426216593
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/15/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Ma. Norma LopezTIME COMPLETED:
04:45 PM
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On 05/15/2023 at 1:30 PM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Pre-licensing Inspection of residence and met with Applicant, Ma. Norma Lopez. 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 5AM to 5:00 PM, Monday- Friday. The Applicant also informed LPAs of the intention to provide care for children 12 months to 10 years of age. There are three (3) adults that lives in the home and three (3) adults have received criminal record clearance.

LPA toured the interior and exterior of the residence with the Applicant. This is a single level home that consists of three (3) bedrooms, two (2) bathrooms, living room, kitchen/dining area and outdoor yard. This home also has a garage with one (1) attached bedroom and one (1) bathroom. Per applicant, children will have access to one (1) bedroom, one (1) bathroom, living room, dining area, and kitchen. Meanwhile, two (2) bedrooms, one (1) bathroom, garage that has one (1) attached bedroom, one (1) bathroom and outdoor yard will be inaccessible to children in care. LPA observed door safety knob on the bedroom doors and garage door to ensure areas are made inaccessible. Applicant will be making some changes to the outdoor yard so that it can be accessible in the future but for now outdoor yard will be inaccessible to the children in care.

LPA observed the living room to have spacing and ventilation for children in care. LPA observed sharps are stored in an elevated cabinet in the kitchen. LPA observed medications for the applicant and her family are stored in the bedrooms of the home which are inaccessible to children in care. LPA observed cleaning compounds are stored under the sink of the kitchen which has a lock, in the garage, and under the sink of the restroom that also has a lock. LPA notes all areas are inaccessible to children in care. The bathroom of the FCCH is observed to be clean and free of toxins. LPA observed all items, equipment, toys and furnishings are in good conditions and age appropriate. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2023
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 FAMILY CHILD CARE
FACILITY NUMBER: 426216593
VISIT DATE: 05/15/2023
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LPA observed a required fire extinguisher (2A10BC) in the home which was purchased on 04/26/2023. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has a combination smoke and carbon monoxide detector which were tested at 2:30 PM and found to be operable.

Applicant informed LPA that she has updated her facility sketch to reflect that the outdoor yard will be inaccessible to children in care. Applicant informed LPA that she will be making changes to the outdoor yard. LPA informed applicant that once changes have been made, applicant will update outdoor facility sketch and an LPA will return to inspection the outdoor yard, prior to applicant being able to use the outdoor yard. LPA did not observe any bodies of water. Per applicant, there are no guns or ammo on site.

LPA's record review revealed Applicant completed Preventative Health training on 04/13/2023. Further, Applicant completed Mandated Reporter training on 03/18/2023 and Pediatric CPR/First Aid (EMSA approved) on 03/11/2023. Applicant completed FCCH orientation on 02/16/2023. LPA reminded Applicant of obligation to maintain current training and certifications. LPA reviewed Applicant's control of property document (mortgage deed). LPA notes applicant is current with all required immunizations. Applicant does not have liability insurance for the home as of yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282).



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 CONT 809-C

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

DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
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 FAMILY CHILD CARE
FACILITY NUMBER: 426216593
VISIT DATE: 05/15/2023
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 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.

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, Ma. Norma Lopez in Spanish due to Spanish being applicant primary language. The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license will be noted as the present, 05/15/2023.

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

DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
LIC809 (FAS) - (06/04)
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