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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420401
Report Date: 12/18/2023
Date Signed: 12/18/2023 11:19:32 AM


Document Has Been Signed on 12/18/2023 11:19 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:MENDEZ, SARA LUZFACILITY NUMBER:
013420401
ADMINISTRATOR:MENDEZ, SARA LUZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 334-7956
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY:14CENSUS: 9DATE:
12/18/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sara Luz MendezTIME COMPLETED:
11:15 AM
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On 12/18/23 at 9:00am, Licensing Program Analyst (LPA) Ashley Akinleye arrived at the home for an unannounced required annual inspection. LPA met with Sara Luz Mendez. There were 5 infants and 4 children in care during the inspection. This family childcare home operates Monday - Friday 8:00am – 5:00pm.

LPA toured the home with Sara Luz Mendez, to conduct a health and safety inspection. The home is a single-story home, and consists of 2 bedrooms, 1 bathroom, living room, kitchen, dining area, patio and backyard. LPA observed that the home is neat and clean with heating and ventilation for the safety and comfort of children in care. The on-limit areas include living room, dining room, kitchen, patio, backyard. The off-limit areas include 2 bedrooms. These areas are made inaccessible by closed and/or locked doors, gates, and visual supervision. LPA observed locks on lower cabinets to prevent access by children. The living room is used for isolation of sick children, away from other children in care. The back yard is used for outdoor play and the yard is fully fenced. LPA did not observe any hazards or dangerous conditions in the yard. LPA observed an ample supply of age-appropriate toys, equipment and activities available for children both indoors and outdoors and observed that they are in good condition. LPA did not observe any bodies of water, toxins, medications or hazardous items that would be accessible to children. The licensees stated that there are no firearms on the premises.

Licensee was reminded that in a large family child care home the ratio for infants in no more than four infants with the capacity up to 12 children and no more than 3 infants with the capacity of 14 children.

Licensee was able to send one infant home during inspection in order to come into compliance.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley AkinleyeTELEPHONE: (510) 926-9152
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MENDEZ, SARA LUZ
FACILITY NUMBER: 013420401
VISIT DATE: 12/18/2023
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The home is equipped with fully charged 2A10BC fire extinguisher, a working carbon monoxide detector, working smoke detector, working telephone, and first aid kits and supplies. The licensee has proof of current CPR/First aid certificates, which expire on 03/2024. The last documented fire drill was conducted on 3/10/22. Licensee was reminded that fire and earthquake drills are to be completed every 6 months.

LPA observed all of the required forms posted. LPA reviewed children's files, staff files and obtained a copy of the current roster.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee Sara Luz Mendez was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated

LPA discussed the safe sleep regulations with licensee Sara Luz Mendez and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee 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.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley AkinleyeTELEPHONE: (510) 926-9152
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MENDEZ, SARA LUZ
FACILITY NUMBER: 013420401
VISIT DATE: 12/18/2023
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LPA reminded the licensees that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. LPA provided the main office number for the Oakland Regional Child Care office (510) 622-2602 for the licensees to call and report injuries or unusual incidents and reviewed the form to follow up in writing within 7 days of the injury/unusual incident. The licensees were encouraged to periodically review regulations, guidelines and Provider Information Notices (PINs) on the website www.ccld.ca.gov.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the 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: https://www.ada.gov/resources/child-care-centers/.

Licensee Sara Luz Mendez was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee Sara Luz Mendez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During inspection licensee did not have proof of current mandated reporter. Licensee states she will send the current copy via email to LPA.

LPA reminded the licensee that the mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

Based upon observation, interview and record review there was 1 deficiency cited today. Please see 809-D for deficiency.

Licensee was also provided with technical advisories for review to assist in maintaining compliance.

Appeal rights were provided to licensee for review.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Sara Luz Mendez.

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley AkinleyeTELEPHONE: (510) 926-9152
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 12/18/2023 11:19 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: MENDEZ, SARA LUZ
FACILITY NUMBER: 013420401

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.5(d)(1)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above because the Licensee had 5 infants in care during inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/25/2023
Plan of Correction
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Licensee shall send one infant home to come into compliance as of 12/18/23, licensee shall also submit a plan to show how she will maintain compliance due to ratio standards.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley AkinleyeTELEPHONE: (510) 926-9152
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023
LIC809 (FAS) - (06/04)
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