013421273-2-21-2023-02-CC-ILOA-CP9RD6-20230221115524

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421273
Report Date: 02/21/2023
Date Signed: 02/21/2023 11:55:34 AM

Document Has Been Signed on 02/21/2023 11:55 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	MENDEZ, SARA MARINA		FACILITY NUMBER:	013421273
ADMINISTRATOR:	MENDEZ, SARA MARINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 499-1932
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94702
CAPACITY:	14	CENSUS:	DATE:	02/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:18 AM
MET WITH:	Sara Marina Mendez		TIME COMPLETED:	11:59 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	On February 21, 2023 at 9:18am Licensing Program Analyst (LPA) Indira Loza met with Licensee Sara Marina Mendez for an Unannounced Required Annual Inspection. Present during the inspection was the Licensee, her finger print cleared husband, and 8 preschool age children in care. The home was toured for a health and safety inspection. The facility operates from 8am – 5:15pm Monday – Friday. The home is a two story house consisting of a living room, kitchen, two upstairs bedrooms, one upstairs bathroom, den, fenced back yard, fenced front yard and garage. The inside of the home was observed to be neat and clean with age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be inaccessible to the child in care. ON LIMITS AREA: The bathroom, living room, den, front yard, and backyard. OFF LIMITS AREA: Both upstairs bedrooms, the garage, and the kitchen. The kitchen is used to walk through to the backyard and is only used to access the outdoor play area. Other than that, the kitchen is blocked off to prevent access by children. ISOLATION AREA: Is in the living room The home has a fully charged 2A10BC fire extinguisher in the living room, a working combined smoke and carbon monoxide detector in the kitchen. The Licensee has provided a working telephone number and email address. The licensee's CPR and First Aid certificate is current and expires on July 2023. Per Licensee, there are no firearms in the home. LPA reviewed two staff and six children's files and obtained a copy of the facility roster. The fire and disaster drill was conducted on December 14, 2022. The Licensee provides lunch and two snacks. *************************************Report Continues on LIC 809********************************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: MENDEZ, SARA MARINA	FACILITY NUMBER: 013421273
	VISIT DATE: 02/21/2023

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. 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: http://www.ada.gov/childqanda.htm
Licensee is providing IMS at this time and needs to submit the written plan for providing IMS to the department.

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensee and discussed the Child Care Licensing Safe Sleep web page athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

There were no citations issued during today's visit.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted
Report and Appeal Rights were provided to Licensee Sara Marina Mendez.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

LIC809 (FAS) - (06/04)

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