198011327-4-23-2024-33-CC-SPEY-D4LVUN-20240423164500

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198011327
Report Date: 04/23/2024
Date Signed: 04/23/2024 04:45:21 PM

Document Has Been Signed on 04/23/2024 04:45 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MENDOZA FAMILY CHILD CARE		FACILITY NUMBER:	198011327
ADMINISTRATOR:	MENDOZA, IRMA & MARTHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 221-2895
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90031
CAPACITY:	10	CENSUS: 3	DATE:	04/23/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Martha and Irma Mendoza, Licensee		TIME COMPLETED:	05:05 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 04/23/24, Licensing Program Analysts (LPA) Staicy Perry conducted an unannounced Annual inspection to the above facility. A COVID risk assessment was conducted upon entry. LPA met with Licensees Martha and Irma Mendoza, whom the reason for the visit was explained. Also present during the inspection was Lilliana Mendoza. Per Irma and Martha, there are 6 children currently enrolled. There were 3 children, and 2 adults present upon arrival. Per Licensees hours of operation are Monday-Friday, 7:00am-5:45pm. This is a one-story home which consists of 2 bedrooms, 1 bathroom, kitchen, living room, front yard (fenced), 3 storage rooms in the back yard, and 1 laundry room in the back yard. The children use the living room, one bathroom, the kitchen, and the front yard. The front yard is used for outside play. Off limit areas include 2 bedrooms and the back yard which includes the storage rooms and laundry room. Facility License, Emergency Disaster Plan, Parent’s Rights Poster, and Earthquake Preparedness Checklist were observed to be posted on the wall next to the entrance. A current children’s roster was available for review. There is telephone via landline that remains at the facility at all times. Parents enter through the gate and go down the long driveway where licensees greet the children and parents. During this visit, all areas identified that are accessible for children to use were inspected for the safety, comfort, and cleanliness. Licensee guided LPA on a tour of the home. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. There are toys and other age-appropriate material available for children. LPA observed a portable AC. The bathroom was reviewed, LPA did not observe anything that can pose danger to the children in care. The kitchen was observed go be clean, organized. Knifes were not seen to be placed made inaccessible to the children which poses a potential danger to the children in care. LPA observed Licensee Irma move knives to an inaccessible area during inspection. Licensee will signed a declaration. The living room area was observed to be clean and orderly. LPA observed to have couches, TV, and plenty of age-appropriate toys for the children to use. The living room was observed to have a child size table with books and activity items. The living room couch is used as an isolation area for an ill child until an authorized representative arrives to pick up the child. All equipment meets the US Consumer Product Safety Commission safety standards. Living room was observed to have a wall heater that is not barricaded and accessible to the children which poses an potential risk to the Health and Safety of the children in care.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 198011327
	VISIT DATE: 04/23/2024

NARRATIVE

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Infant Care: Per Licensee, she has 1 infant under 12 months at this time and does have 1 children enrolled who is between the age of 1- 2 years of age. LPA reviewed Safe sleep regulations / documents, 15-minute sleep check documentation for infants 0-24 months were unable to be reviewed and are not on file for the departmen which poses an potential risk for the children in care. LPA observed and inspected sleeping equipment for infants. LPA was informed by licensee that play pins are used for infants in care. LPA observed that play pins do not hinder the entrance or exit to and from the space they are sleeping in. LPA observed that crib is free from loose articles and objects. There are no objects hanging above or attached to the side of the crib. Mattresses were observed to be firm and covered with a fitted sheet that is appropriate to the mattress size. Each infant has their individual bedding and is washed weekly as required. Soiled bedding is replaced when wet or soiled and is placed in an area inaccessible to infants. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping. LIC9227 was not observed to be on file.

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Per Licensee, there are no poisons in the home. LPA advised that any poisons should be locked under key or combination lock. Licensee states that are no firearms or weapons stored in the home.

The valve on the required 2A 10BC fire extinguisher indicates fully charged. LPA did observe receipt with proof of purchase date of 4/23/24. Smoke and carbon monoxide detectors were tested and are operable and were observed to be in the living room.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on April 19, 2024. The home is observed to be clean and orderly. There are first aid supplies available. LPA observed to have a first aid kit available in the bathroom area.

Per licensees, food is provided by licensees. Licensees were advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated. Licensee provides Am snack, Breakfast, lunch and PM snack. Licensee does transport the children for school drop offs and school pickups.

LPA toured the outdoor play area and inspected its safety and condition. LPA observed perimeter fencing which is free of miscellaneous debris/hazards. All trees, shrubs and plants are maintained. Outdoor play yard was observed to have toys for the children to play. LPA observed plants that are not poisons and or sharp to the touch.

Licensees’ records were reviewed. The licensees Martha and Irma have not completed training on preventive health practices including Pediatric First Aid and CPR. Licensees Pediatric First Aid and CPR was not available for department review which poses a potential risk to the Health and Safety of the children.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 198011327
	VISIT DATE: 04/23/2024

NARRATIVE

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Licensees Martha and Irma did not have immunization's available for review during inspection.

LPA did not observe that Licensees Martha and Irma to have to updated proof of Mandated Reporter AB 1207 compliant Child Care Training Certificate on file for the department to review. www.mandatedreporterca.com. Licensees training expired on 4/5/22.

LPA observed children’s records were reviewed, including emergency information, and were observed to be incomplete.

LPAs created an LIC 857, Children’s Record Review, and LIC 811, confidential names which documents persons living in the home and children’s files reviewed during this inspection.

Per licensees, there are no pets on the premises.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensees, no one smokes in the home.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family childcare facility.

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/.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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-care-licensing/process.

Licensee 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.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 198011327
	VISIT DATE: 04/23/2024

NARRATIVE

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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.

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 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.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at www.ccld.ca.gov.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California

During the exit interview, Martha and Irma confirmed that there are no Registered Sex Offenders living in the facility.

Currently, the licensees, Martha and Irma in compliance with California Code of Regulations Title 22. No deficiencies cited.

A notice of site visit was given and must remain posted for 30 days. Appeal rights were discussed and provided.

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

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/23/2024 04:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 198011327
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, LPA observed an open face heaters open and not screened which is accessable by children which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/17/2024
	Plan of Correction
1 2 3 4	Licensee stated that a screen will be purchased to make the wall heater inaccesable to the children. Licensee wll provide proof (photos) by the POC date of 5/17/24 to LPA via email.

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations and record review, the licensee did not comply with the section cited above, 15 mnute sleep logs were not being conducted for the infants in care, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/17/2024
	Plan of Correction
1 2 3 4	Licensee will provide LPA with a declaration stating 15 minute sleep log will be conducted and kept on file for 3 years for the department to review. Licensee will watch infant safe sleep vidoe on CCLD website and provide a summary of what they learned by POC date of 5/17/24 to LPA via email.

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

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/23/2024 04:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 198011327
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations and record review, the licensee did not comply with the section cited above, 3 out of 3 files did not have the required mandated reporter training, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/17/2024
	Plan of Correction
1 2 3 4	License will complete training and submit certification to LPA via email by POC date of 5/17/24.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations and record review, the licensee did not comply with the section cited above, 3 out of 3 files did not have the required Pediatric Cardiopulmonary resuscitation and pediatric first aid available for department to review, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/17/2024
	Plan of Correction
1 2 3 4	License will complete training and submit certification to LPA via email by POC date of 5/17/24.

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

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/23/2024 04:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 198011327
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 observations, interviews and record review, the licensee did not comply with the section cited above, 3 out of 3 files did not have immunizations, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/17/2024
	Plan of Correction
1 2 3 4	Licensee will provide LPA with proof of immunizations for 3 out of the 3 files checked to LPA via email by POC date of 5/17/24.

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations, interviews and record reviews, the licensee did not comply with the section cited above in 2 out of 4 children did not have their immunizations poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/17/2024
	Plan of Correction
1 2 3 4	Licensee will provide LPA with proof of immunizations for 2 out of the 4 children to LPA via email by POC date of 5/17/24.

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

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC809 (FAS) - (06/04)

Page: 7 of 8

Document Has Been Signed on 04/23/2024 04:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 198011327
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(c)(2)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations, interviews and record review, the licensee did not comply with the section cited above in 1 out of 4 files did not have Individual Infant Sleeping Plan available for review which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/26/2024
	Plan of Correction
1 2 3 4	Licensee will provde LPA with a copy of LIC 9227 form via email by POC date of 4/26/24.

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.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy Perry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC809 (FAS) - (06/04)

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