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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700415
Report Date: 04/13/2021
Date Signed: 04/14/2021 04:41:43 PM

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:MEJIA FAMILY CHILD CAREFACILITY NUMBER:
197700415
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
04/13/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Bessy MejiaTIME COMPLETED:
11:28 AM
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Licensing Program Analyst (LPA) Thompson-Miller conducted a Tele-Visit with Licensee Bessy Mejia, who guided analyst on a tour of the facility for a Case Management Change of Capacity (from 8 children to 14 children) inspection. Licensee assistant Gina Euceda present and assisted with translation. This is a single story 3 bedroom, 2 bathroom home with kitchen/dining, living room, laundry room and detached garage. Family members residing in the home include two adults (Licensee, Licensee spouse) and no children. Days/hours of operation will be Monday through Friday from 6AM to 6PM. Licensee assistant and LPA toured the home indoor and outdoor to ensure the home meets licensing requirements. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Home is clean and orderly, fireplace is screened, age appropriate toys and play equipment, working smoke detector, carbon monoxide detector, operable Fire Extinguisher (2A10BC), no one smokes in the home. There is a designated area for ill child(ren) as necessary, no weapon/firearms, facility sketch complete and current, off limit areas include #3 bedroom (key lock) and bathroom #2, working telephone (cell), poisons and cleaning items inaccessible to children (upper cabinet in kitchen laundry area). Bedroom #1, Bedroom #2 and the living room used for child care.

Kitchen/bathroom: The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Kitchen has a safety gate at hallway entrance. Sharp items (knives) located in upper cabinet. Cabinet under kitchen sink is empty at this time. Toilets and faucets are clean and operable and home has a clean fully stocked of food refrigerator/freezer.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-MillerTELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: MEJIA FAMILY CHILD CARE
FACILITY NUMBER: 197700415
VISIT DATE: 04/13/2021
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Outdoor: The property backyard is off limits. The garage is detached and is off limits. Garage used by owner (landlord) of the property. The front area is used as the play area. Licensee and staff shall supervise children at all times while at play in the front yard. This play area is clear and clean of debris. There are age appropriate toys. There is a gate located on the rear left side and the right side is blocked.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 01/14/2022. The electrical outlets are covered. Children nap in play pens and mat with pillow attached.

Documents Provided and or Discussed: The following were observed to be in regulation of Title 22 requirements: Seat Belt Safety, Safe Sleep poster observed.

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

Names of all adults living in the home: All adults living/residing in the home are fingerprint cleared and associated.



Ready for licensure for a Large Family Child Care License with capacity of 14 children.
Exit interview conducted and a copy of this report will be emailed to Licensee Bessy Mejia and Gina Euceda (due to COVID-19). The read receipt is in lieu of a signature.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-MillerTELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021
LIC809 (FAS) - (06/04)
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