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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197400488
Report Date: 08/30/2022
Date Signed: 08/30/2022 03:26:14 PM


Document Has Been Signed on 08/30/2022 03:26 PM - 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:MENJIVAR FAMILY DAY CAREFACILITY NUMBER:
197400488
ADMINISTRATOR:MENJIVAR, OFELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 365-6247
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:12CENSUS: DATE:
08/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:09 PM
MET WITH:Ofelia MenjivarTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPAs) Justin Dorsey and Andrew Alemoh met with Licensees Diana Menjivar and Ofelia Menjivar who guided analysts on a tour of the facility for the One Year Required Inspection. This is a two story 3 bedroom, 2 and a half bathroom home with kitchen, dining room area, living room, family room, and converted detached garage for limited day-care use. There is no pool on the premises. Upon arrival LPA observed 4 children and 1 infant with the licensees.

Physical Plant: Main care is provided in the detached garage and living room. Children use the bathroom in the home near the kitchen. Children have access to the living room, detached garage, children's dining area (near kitchen) children's bathroom and cemented backyard area. Off limit areas include the homes entire upstairs, kitchen, family room area, dining area, and backyard garden. The home was inspected inside and out for safety, comfort, cleanliness, telephone service (,land line, cell), heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (locked in kids bathroom, as well as locked in detached garage.) medicines (stored in top kitchen cabinet) and hazardous items (sharp knives inaccessible in locked kitchen drawer) that can pose a danger to children. There is no fireplace on the premises. The home has safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, and Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in detached garage. Per Licensee there are no weapon/firearms in the home.

The last fire/earthquake drill was completed 08/12/22. Roster complete and maintained current.

Bathroom: Children's bathroom is free of hazards (child care bathroom). Toilet and faucet is clean and operable.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MENJIVAR FAMILY DAY CARE
FACILITY NUMBER: 197400488
VISIT DATE: 08/30/2022
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Kitchen: Sharp utensils are inaccessible and are locked in kitchen drawer. Per licensee breakfast, AM snack, lunch, PM snack and dinner are provided. LPA reminded licensee If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies are locked in children's bathroom and detached garage. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard is safe for children and completely fenced. Children have access to the front concrete area of the homes backyard. The back garden portion of the backyard is off-limits and only accessed if children are directly supervised. The on-limits portion of the backyard has concrete areas for children to play. LPA observed the toys in the backyard to be in safe condition.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expire 11/23/23. Mandated Reporter expires 01/5/24. Children nap on mats in the living room area.

Documents discussed: Title 22 Personnel Records 102416.1, Safe Sleep PIN 20-24-CCP, LIC 9227 and Infant Sleep Log.

Licensee Diana 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 webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Diana 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.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Diana Menjivar.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
LIC809 (FAS) - (06/04)
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