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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045405273
Report Date: 05/29/2019
Date Signed: 05/29/2019 10:02:13 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:MENDOZA, ROSA FAMILY CHILD CARE HOMEFACILITY NUMBER:
045405273
ADMINISTRATOR:MENDOZA, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 894-8118
CITY:CHICOSTATE: CAZIP CODE:
95926
CAPACITY:14CENSUS: 7DATE:
05/29/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rosa MendozaTIME COMPLETED:
10:05 AM
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An annual inspection was made to the facility by Licensing Program Analyst (LPA), Chris Krogstad. A review of personnel report on 5/08/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently two adults living in the home.

During today’s inspection the home and grounds were toured. The licensee and her two assistants were supervising seven children and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 6am to 6:30pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. There is a dedicated child care room off the kitchen of the home. The kitchen, living room and hallway bathroom are accessible to children. The bedrooms are off-limits and were inaccessible with locked doors. The home was clean and orderly. There were safe toys and equipment available for children. There is a working telephone in the home. The licensee has current pediatric CPR and First Aid certification, which expire 1/13/20. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. Poisons were locked in the detached shed. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms or ammunition stored on site and none were observed. Children use the fully fenced back yard as the outdoor play area. There were no pools or any other bodies of water observed. Seven children's records were reviewed at 9:15am; all required emergency information, parent's rights and immunization records were on file. The licensee is not providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. 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 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, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices brochure, were reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.
There were no Title 22 deficiencies cited during today's inspection
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Christen KrogstadTELEPHONE: (530) 895-4230
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
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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