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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416362
Report Date: 05/08/2019
Date Signed: 05/08/2019 09:54:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
197416362
ADMINISTRATOR:MENDOZA, ELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 387-6751
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 6DATE:
05/08/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Elena Mendoza, DirectorTIME COMPLETED:
10:12 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Shandra Powell and Keyona Scott conducted an unannounced POC (Plan of Correction) inspection to ensure that the Type A deficiencies cited on 05/07/2019 regarding Complaint Control Number: 30-CC-20190430153805 have been cleared. LPAs met with Elena Mendoza, Licensee, who guided analysts on a tour of the facility. There were 8 children and 4 staff present during this inspection. Licensee Elena Mendoza was also present. The following has been observed:

· LPA's reviewed Notice of Site Visit to be posted at Entry of home with Complaint Report (Type A) attached.
· LPA's reviewed each child's file in attendance. LPA's observed LIC 9224 Acknowledgement of Receipt of Licensing Reports to be signed with Representative's signature in Seven of the Eight files of children in attendance. Director stated she will have Child #8 representative sign Acknowledgement of Receipt Form and placed in folder at the close of business, today.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, no deficiencies are being cited.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.
Failure to maintain posting as required will result in a civil penalty of $100.00.
LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov.

LPA's provided Director with the following pamphlets: A Child Care Provider's Guide to Safe Sleep and Never Ever Shake a Baby. LPA S. Powell will mail pamphlet on a Child's Guide and Techniques to Prevent Children Biting
Exit interview was conducted with Elena Mendoza, Director, Appeal rights provided and discussed.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
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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