503911553-8-27-2021-04-CC-NLOI-C6APKM-20210827112322

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503911553
Report Date: 08/27/2021
Date Signed: 08/27/2021 11:23:39 AM

Document Has Been Signed on 08/27/2021 11:23 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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	LOPEZ, KARLA FAMILY CHILD CARE		FACILITY NUMBER:	503911553
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/27/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Karla Lopez		TIME COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Prior to today's inspection, LPA telephoned call applicant and conducted the COVID-19 Emergency Response Tele-Inspection Screening Process. On August 27, 2021, Licensing Program Analyst (LPA), Norma Lomeli met with Applicant, Karla Lopez for a pre-licensing inspection. Applicant, her significant other and one minor child reside in the home. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance. Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed: This is a single story, three bedrooms and two bathrooms home and children will have access to the living room, kitchen and hallway bathroom. Off-limits rooms are made inaccessible by use of child proof plastic door knob covers. There is a fireplace in the living room that applicant states it will not be used during day-care hours. LPA observed children size furniture, children's cubbies, safe toys and books for the day care children. Also observed a parents board. Children will nap in the living on mats. Infants will nap in play yards. Applicant understands she is to supervise children at all times. Facility has 3A40BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place. Applicant’s Pediatric CPR and First Aid certification was completed through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on April 11, 2023. (Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: LOPEZ, KARLA FAMILY CHILD CARE	FACILITY NUMBER: 503911553
	VISIT DATE: 08/27/2021

NARRATIVE

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Preventative Health and Safety class was completed on April 22, 2021.
Knives are store inside a plastic container that is located in a top kitchen cabinet. Medications are stored inside a top kitchen cabinet. Cleaning compounds are stored in the cabinet that is located underneath the kitchen sink and made inaccessible by the use of a magnetic child proof lock. Other cleaning compounds are located in the inaccessible garage on a top shelf.
Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
There are no bodies of water in the home or premises.
Applicant states there are no pets in the home or on the premises.
Applicant states there are no firearms, ammunition or poisons in the home or premises.
Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
Applicant states she will not be transporting day care children. Applicant understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
Fenced backyard has a cemented area and soiled area for the day care children. There is a Step 2 swing/slide play structure, there is a Teether Toter, a Step 2 Playhouse, a Caterpillar Climbing Tunnel and other safe toys. LPA also observed a patio porch for shade.
SB 792 immunizations verified and on file.
Applicant completed the Mandated Reporter Training on April 7, 2021.
LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given to applicant.

(Continued on LIC809-C):

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: LOPEZ, KARLA FAMILY CHILD CARE	FACILITY NUMBER: 503911553
	VISIT DATE: 08/27/2021

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. She is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 7:00 AM to 6:00 PM and as arranged. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.

Applicant is advised the following items must be corrected and documentation be sent to CCL within the next 30 days to avoid possible withdraw.

Applicant will store poisons under key lock. LPA observed a can of Home Defense, a can of Round up, RAID foggers and ant bait in the garage.
Applicant will anchor to the ground the Step 2 swing/slide play structure and the Teether Toter that is located in the backyard.

Pending verification of corrections of the above items and a final review of her application, licensure as a Small Family Day Care Home capacity of 8 children* ages under 18 years will be recommended.

SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

LIC809 (FAS) - (06/04)

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