197412854-6-7-2019-12-CC-JNEL-BCWMRU-20190607095055

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197412854
Report Date: 06/07/2019
Date Signed: 06/07/2019 09:51:05 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME:	MONDRAGON FAMILY CHILD CARE		FACILITY NUMBER:	197412854
ADMINISTRATOR:	MONDRAGON, REYNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 205-7204
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93550
CAPACITY:	14	CENSUS: 4	DATE:	06/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:23 AM
MET WITH:	Reyna Mondragon		TIME COMPLETED:	10:05 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	Licensing Program Analyst (LPA) Neal met with licensee, Reyna Mondragon, for the purpose of a Random inspection. This is a two story 3 bedroom, 3 bathroom home with kitchen/dining, living room, child care room and garage. Family members residing in the home include 2 adults (licensee, spouse) and no children. Parents enter child care through a gate on the left side of the home that leads to the backyard entrance. Parents use door bell and there is a wrought iron gate. Incidental Medical Services (IMS) were discussed. Main care is provided in the child care rooms located at the rear of the home. There is one large room and one smaller room for infants. Children use the bathroom through a door in the large child care room. Child lock was observed on cabinet under the sink. Children have access to the backyard. Off limit areas include the home's entire upstairs, kitchen (French doors with safety knob), living room and the garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds (under kitchen sink), medicines, and hazardous items that can pose a danger to children. Facility roster complete and maintained current. Medications are made inaccessible in the off limits kitchen. Sharp knives are stored in kitchen drawer with safety latch. Fire/earthquake drills are current. Stairs inaccessible to children (no access).

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: MONDRAGON FAMILY CHILD CARE	FACILITY NUMBER: 197412854
	VISIT DATE: 06/07/2019

NARRATIVE

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Children play in the backyard. There is a grass and concrete area for active play. There is a large jungle gym with swing that is anchored. On the right side of the yard there is a shed for storage. Children do not play on the right side of the home. Licensee has no pets.
Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. There are age appropriate toys and napping equipment on the premises. Children nap on mats in the playrooms. The required fire extinguisher (2A10BC), carbon monoxide detector and smoke detector are in operable condition. Fireplace is properly screened in off limits living room. Home has central AC and heat. Current pediatric CPR/First Aid expires 5/9/2021. Mandated Reporter Training for Child Care was completed 5/9/2019. Licensee was reminded Mandated Reporter training needs to be completed every 2 years. Licensee has a First Aid kit. Required documents are posted on the parent board.

The following was discussed with the licensee:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home and in those areas of the family child care home where children are present (24/7 ban) State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: MONDRAGON FAMILY CHILD CARE	FACILITY NUMBER: 197412854
	VISIT DATE: 06/07/2019

NARRATIVE

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Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1^st offense and up to $3000.00 for the 2^nd offense within a 12 month period, PER PERSON.

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 was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent and a copy of the Acknowledgment of receipt of licensing report (LIC9224) must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

No deficiencies were cited during todays inspection.
Exit interview was conducted and a copy of report was read and provided to the licensee on this date.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

LIC809 (FAS) - (06/04)

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