136610501-10-29-2020-20-CC-MHOD-BUUMJX-20201029093954

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 136610501
Report Date: 10/29/2020
Date Signed: 10/29/2020 09:40:41 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	MENDOZA, MARIA FAMILY CHILD CARE		FACILITY NUMBER:	136610501
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	10/29/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Maria Mendoza, Licensee		TIME COMPLETED:	09:45 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 10/29/2020, at 9:00 am, Licensing Program Analyst (LPA), Michelle Hood conducted an unannounced video-conference case management inspection via WhatsUp App, due to the COVID-19 outbreak, with licensee. LPA Michelle notified licensee the purpose of the inspection was for a change of capacity regarding and the licensee led LPA on a tour of the facility. There were two (2) children at the facility during the time of the inspection. On 10/27/2020, a fire clearance was approved for 14 children. Licensee will use the following areas for child care: living room, kitchen (safety latches), bedroom #1, bathroom #1, TV room and backyard play area. The off limits are all made inaccessible via safety gates and door knob covers. The stairs are barricaded with a safety gate. There are no bodies of water observed during time of inspection. There is a sufficient amount of age appropriate toys, games, and books available. The home was clean and orderly during inspection. The fire extinguisher is rated 3-A;40; BC, smoke alarm and carbon monoxide detector are operational. The is a working telephone in the home and all required forms are posted. Licensee stated that there are NO firearms or ammunition on the property. All adults living or working in the home have been fingerprint cleared and associated. LPA reviewed one (1) child's file. Licensee will email LPA a copy of the facility roster no later than 10/30/2020. Last fire/disaster drill was conducted 06/21/2020. Pediatric CPR and First Aid certification expire 01/2022. LPA discussed with Licensee maintaining supervision of day children at all times. LPA reviewed the following with licensee: SIDS, car seat law, reporting requirements, shaken baby syndrome and care and supervision. Licensee was also reminded the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care. 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.html

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Michelle Hood	TELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2020

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MENDOZA, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 136610501
	VISIT DATE: 10/29/2020

NARRATIVE

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The maximum capacity for a large family child care home: 12 children (with a qualified assistant) with no more than 4 infants; or (with landlord consent) 14 children (with a qualified assistant) with no more than 3 infants, 1 child enrolled in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home. When there is no Qualified Assistant, 14 years of age or present, the capacity reverts back to the requirements for a Small Family Child Care. To access our Regulations and Forms please use our WEBSITE: http://ccld.ca.gov.

A copy of the case management report, Notice of Site Visit – LIC 9213 and appeal rights (LIC 9058) will be e-mailed to the licensee and the licensee was advised that acknowledgement of receipt of the report and appeal rights are to be received within twenty-four hours. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

Sandra Espana translated in Spanish for licensee.

A Regular Large Family Child Care Home license may be issued for 14 children upon final file review.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Michelle Hood	TELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2020

LIC809 (FAS) - (06/04)

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