197414307-4-14-2025-12-CC-CHEH-DFQQLP-20250414121617

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197414307
Report Date: 04/14/2025
Date Signed: 04/14/2025 12:17:32 PM

Document Has Been Signed on 04/14/2025 12:17 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:	MENENDEZ FAMILY CHILD CARE		FACILITY NUMBER:	197414307
ADMINISTRATOR/ DIRECTOR:	MENENDEZ, MARIA A.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 992-1224
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 3	DATE:	04/14/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:35 AM
MET WITH:	Maria Menendez/ Licensee		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

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 4/14/2025, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Required annual inspection at the Menendez Family Child Care. Upon arrival, the LPA met with the licensee, Maria Menendez, who guided the LPA on a facility tour. Individuals that reside in the home include 6 adults (licensee and 5 adults) and no minor children. During this inspection, 3 childcare children with licensee and 2 assistants were present. An adult resident (Adult #4) has not completed the required Livescan fingerprinting or been associated with the facility. Additionally, four other adult residents in the home have not provided documentation of TB clearance. Per the licensee, the hours of operation are Monday to Sunday for less than 24 hours. Incidental Medical Services (IMS) were discussed. Per the licensee, she does not have children who need IMS. The home is set up as follows: This is a two-story, 5-bedroom, 3-bathroom home with a kitchen, living room, formal dining room, laundry room, family room, and garage. The licensee stated No childcare children sleep or eat in the Garage. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The house has central heating and air conditioning. All windows have screens free of cracks, bugs, and debris.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: MENENDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414307
	VISIT DATE: 04/14/2025

NARRATIVE

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Main Area: Main care is provided in the living room, family room, classroom area near the front entrance, and playroom/game room—garage (has a permit). Children use the bathroom in the hallway right near the classroom area. They have access to the living room, family room, classroom, and playroom/game room.
Off-limit areas include all bedrooms, the entire upstairs (barricaded by a safety gate), bathrooms #2 and #3 (upstairs), and the laundry room (upstairs).
Living room, family room, classroom area near the front entrance, and playroom/game room- garage (has a permit): LPA observed age-appropriate toys and furniture for the children in the designated childcare areas. Several plastic storage bins were observed in which games and toys are stored for the children. There are games and books on the premises of this facility. There are mats on the floor with educational/learning activities. The mats were observed to be in good condition. A TV plays educational videos for children, and an adult-size couch. In the family room, additional toys were observed to be stored in cubbies.
Children's bathroom (#1): The Children will use the bathroom down the hallway to the right. The bathroom was toured and inspected, and the sink/toilet is in operable condition. The toilet and faucets are clean, safe, and operable. LPA reminded that all poisons and medications must be inaccessible to children with child safety latches on the sink cabinet. The shower/tub is free of hazards (childcare bathroom). LPA observed cleaning supplies and personal items in the children's bathroom. The toilet and faucet are clean and operable. Cleaning supplies are safely latched under the bathroom sink.
Kitchen/Dining Room: The kitchen was inspected to ensure that hazardous and dangerous items were inaccessible to children.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

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: MENENDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414307
	VISIT DATE: 04/14/2025

NARRATIVE

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LPA observed sharp utensils and medications stored in kitchen drawers without safety latches on the cabinets. Cleaning supplies were also stored under the kitchen sink, inaccessible to children with safety latch. The licensee stated that the assistant had placed the knives in the drawers; however, the assistant claimed she was unaware of this. As for the medications, the licensee explained that the safety latch had broken the previous week.
Backyard: The backyard was inspected. The children use it for outdoor play. It is completely fenced (with block cement). There is no body of water. An outdoor air conditioner is inaccessible to children, and a barricaded fence on the side of the home prevents access. LPA observed age-appropriate toys, play equipment, and turf for outdoor play.
Others: Two AC units are securely gated and inaccessible to children. No Bodies of Water on this facility. Electrical Outlets: All unused outlets are plugged in; licensee reminded to ensure all remain covered. Fire Extinguisher: One 2A10BC extinguisher observed in the kitchen, meets standards, and is inaccessible to children. The fireplace is properly screened with mirror glass doors and is inaccessible to children. The Licensee was instructed to secure all window cords to keep them out of children’s reach. Sick children will be isolated in the game room. Designated nap areas with 12 mats available; children nap under supervision. 4 children need overnight care. Pets: 1 dog, and the dog is not intact with children. Phone Service: Working landline or cell phone available. Smoke/Carbon Monoxide Detectors: All tested and functioning correctly. A Safety gate blocks access, making the stairs inaccessible to children. The complete first aid kit is stored in a locked closet. The licensee provides transportation. The licensee holds a valid CA driver’s license, vehicle insurance, and registration. Weapons/Firearms: None present per licensee and not observed by LPA.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

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: MENENDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414307
	VISIT DATE: 04/14/2025

NARRATIVE

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Documentation:
Child files: LPA reviewed 5 children's records. The records are complete.
Infant Sleeping Plan (LIC 9227) and Sleeping Log: Two infants were enrolled in the facility. The licensee does not have or save the infant's Sleeping log. LPA shared the Regulation with the licensee. All information needs to be kept for three years.
Staff Personnel File: LPA observed 3 staff members ' information. The licensee did not have a sub assistant’s 9052, IZ, TB test and LIC 9108.
Immunization: The licensee has the required immunizations (MMR and DTaP). The licensee and her assistants provided a written statement declining the influenza vaccination.
CPR/First Aid: LPA observed that the licensee has current Pediatric CPR and First Aid Training with an expiration date (of 02/27) 1 hour of nutrition training and (8) hours of Preventive Health and Safety Training.
Mandated Reporter Training: The licensee and her assistant were able to provide their training certifications
Facility fees: Per the Licensing Information System, annual facility fees were current.
Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and performed. Two AC units are securely gated and inaccessible to children. No Bodies of Water at this facility. Electrical Outlets: All unused outlets are plugged in; licensee reminded to ensure all remain covered. Fire Extinguisher: One 2A10BC extinguisher observed in the kitchen, meets standards, and is inaccessible to children. The fireplace is properly screened with mirror glass doors and is inaccessible to children. The Licensee was instructed to secure all window cords to keep them out of children’s reach. Sick children will be isolated in the game room.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

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: MENENDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414307
	VISIT DATE: 04/14/2025

NARRATIVE

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Medications/Cleaners are store in an upper cabinet. It will need to put the safety latch. Designated nap areas with 12 mats available; children nap under supervision. There are 4 children need over night car. Pets: 1 dog and dog does not intact with children. Phone Service: Working landline or cell phone available. Smoke/Carbon Monoxide Detectors: All tested and functioning correctly. A Safety gate blocks access, making the stairs inaccessible to children. Complete First Aid kit stored in a locked closet. The licensee Provides transportation. licensee holds valid CA driver’s license, vehicle insurance, and registration. Weapons/Firearms: None present per licensee and not observed by LPA.
on 04/04/2025.
LPA observed that the licensee does have posted the facility license, emergency disaster plan, earthquake preparedness, and parents' rights poster as required.
The following information was discussed with the licensee:
o A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code sections 1596.848(b) and (c). State law prohibits baby walkers, bouncy seats, exersaucer, and other items that fall into that category.
o Capacity requirements, Roster requirements, Posting requirements, and Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children's and provider's files and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
o The 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

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

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: MENENDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414307
	VISIT DATE: 04/14/2025

NARRATIVE

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o Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. The licensee was made aware that it is their responsibility to know the regulations, as well as that of anyone who assists in providing care. The licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility's phone number; if the phone number is changed, licensing must be notified.
o Mandatory Forms for the children's files and provider's files.
o Our Quarterly updates come out every 3 months. They are also now in Spanish. Please log in to the CCLD website, or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
o Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
o Requirements for fire drills, earthquake drills, and documentation for both.
o The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.
o The licensee is reminded that 100% supervision is required for children at all times.
o The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
o The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family childcare home where children are present (24/7 ban).

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

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: MENENDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414307
	VISIT DATE: 04/14/2025

NARRATIVE

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· Family Child Care Homes Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
· IF THERE IS NO CHILD AT THE FACILITY THAT CURRENTLY NEEDS IMS, USE AS FOLLOWS: Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.
· Centers and Family Child Care Homes Licensee [or facility representative] was informed of the MyChildCarePlan.org website, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
· Family Child Care Homes During the exit interview, the LICENSEE ****, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
· Family Child Care Homes A notice of site visit was given and must remain posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

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: MENENDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414307
	VISIT DATE: 04/14/2025

NARRATIVE

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· To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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-carelicensing/ inspection-process.

Deficiencies cited: (See LIC 809D). The following Type A and B deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.

An exit interview was conducted, and the report was reviewed with the licensee, Maria Menendez.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

LIC809 (FAS) - (06/04)

Page: 9 of 12

Document Has Been Signed on 04/14/2025 12:17 PM - It Cannot Be Edited

Created By: Carol Heath On 04/14/2025 at 11:09 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MENENDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414307
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Type A

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above. During today's inspection, the licensee told LPA that there are 5 adults renting the room form her. Adult #4 was not appear to the Guardian and assoicated to the facility. According to the licensee, she called RO around 4-5 months ago and Ro staff told the licensee, the Adult #4 is in the Guardian system However, Adult #4 is not assoicated with the facility, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/14/2025
	Plan of Correction
1 2 3 4	The licensee send adult #4 to the Livescan. The licensee agreed that Adult #4 will not return to the facility until it is cleared and associated to the facility.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:

	Carol Heath
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

LIC809 (FAS) - (06/04)

Page: 10 of 12

Document Has Been Signed on 04/14/2025 12:17 PM - It Cannot Be Edited

Created By: Carol Heath On 04/14/2025 at 11:09 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MENENDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414307
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above. During today's inspection, LPA observed kniefs and medication in the draws and cabints without the safety latch, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/16/2025
	Plan of Correction
1 2 3 4	The licensee will get a safety latch for the medication cabint and talk to her assistants to put the knife on the top cabint after cooking or cleaning.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above. which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/18/2025
	Plan of Correction
1 2 3 4	The licensee will ask all adults living in the facility to complete their TB test. The licensee will email the results to LPA by 4/18/2025.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:

	Carol Heath
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

LIC809 (FAS) - (06/04)

Page: 11 of 12

Document Has Been Signed on 04/14/2025 12:17 PM - It Cannot Be Edited

Created By: Carol Heath On 04/14/2025 at 11:09 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MENENDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414307
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interviewre and cord review, the licensee did not comply with the section cited above. During today's inspection, there were 2 infants enrolling at the facility. However, the licensee did not keep the infants' sleeping log. LPA was only able to review Januar 2025 to present, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/14/2025
	Plan of Correction
1 2 3 4	The licensee agreed to keep all the documention for 3 years for the department inspection.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:

	Carol Heath
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

LIC809 (FAS) - (06/04)

Page: 12 of 12