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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015293
Report Date: 09/11/2019
Date Signed: 09/11/2019 10:37:08 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
198015293
ADMINISTRATOR:MENDOZA, CLAUDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 965-4956
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY:14CENSUS: 9DATE:
09/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:14 AM
MET WITH:Claudia MendozaTIME COMPLETED:
10:45 AM
NARRATIVE
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Annual Random inspection conducted by Licensing Program Analyst (LPA) Jennifer Hua LPA met with licensee, who guided analyst on a tour of the facility. Upon arrival, no children in care. Per licensee, currently her program runs M-F from 8:45am- 11:45am. LPA observed children arrived at 8:45am. Also, present during this visit volunteer Jatziny E. Stopnani-Garcia (Aunt of child in care) and licensee's Mom Gaby Guzman who assists with the day care.. Per licensee, family members living in the facility are 3 adults (licensee, her spouse, Gabriel and adult son Omar) and 1 minor child.This is a two story home which consists of 5 bedrooms, 3 bathrooms. The children use the bathroom downstairs, living room, dining room and kitchen area, and fenced backyard. Per licensee, the rest of the home is off limits. The LPA toured all areas accessible to children during this visit. Per licensee, there are no weapons, fire arms at the facility. There is a swimming pool on the premise and the pool is surrounded by iron fence and walls and children do not have access. However, the spring on the gate needs to be readjusted as the gate does not self latch. The other gate is locked with dead bolt lock and another lock on latch. Licensee, said she lost key on that gate. Smoke/carbon detectors in place and tested. Fire extinguisher is fully charged and serviced on 9/28/18.

Licensee is not current in Pediatric First Aid/CPR . Certificate expired on 1/22/19.

Child Care Roster, Disaster Plan, and Children's Records were reviewed.Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement. The following was discussed: Individuals who are 18 years of age or older living/working in the home must be finger print cleared prior to being on the premise.. Individuals within one month of their 18th birthday must be fingerprinted immediately. The existing, immediate $100 per individual Civil Penalty has been increased to an immediate $100 per day Civil Penalty, for a maximum of five days for the first violation and a maximum of 30 days for subsequent violations. If an individual has a clearance with the Department a criminal record clearance may be transferred. LIC 9182 Criminal Background Clearance Transfer Request may be used

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 198015293
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2019
Section Cited

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Immunization Requirements. Effective 9/1/16, all staff & voluntters are required to obtain immunizations for Pertussis, Measles and Influenza. The requirement is not met as evidenced by: Records not available for vonlunteer Jatziny & assistant Gaby Guzman This is a potential risk to the health and safety of children in care.
Type B
09/12/2019
Section Cited

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Operation of a Family Child Care Home. All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.
Gates shall swing away from the pool,
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self-close and have a self-latching device located no more than six inches from the top of the gate. The requirement is not met as evidenced by: The gate does not self latch, licensee has to push gate for it to latch. The gate is lock with a key an lock. This poses a potential risk to the health and safety of children in care.
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Type B
10/30/2019
Section Cited

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Personnel Requirements. The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric pediatric first aid/CPR. The requirement is not met as evidenced by: Licensee's certificate expired on 1/22/19. This poses a potential risk to the health and safety of children in care.
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: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 198015293
VISIT DATE: 09/11/2019
NARRATIVE
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Rooms that are off-limits need to be made inaccessible during operating hours. No smoking, No infant walkers, Johnny jumpers, exersaucers, bouncers and any other item that falls into that category, earthquake – fire, disaster drills and safety, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal records, child abuse clearance and criminal records transfer requirements, SIDS, Never Shake A Baby. No infants enrolled. Per licensee, Liability insurance for child care policy in placed. Licensee was informed all staff need to complete the Mandated Reporter Training on department website at http://www.mandatedreporterca.com/ Licensee completed her training on 4/4/18. Certificate 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) 514-0388 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

· Dog(s) and or pets should be isolated from children in care. 1 medium size dog on premise and is gated.
· It is recommended that a First Aid kit be available on premises.
Outdoor supervision required at all times. If outdoor area not adequately fenced provider must be with children at all times when outdoors.

Deficiencies cited on attached 809D.

Exit interview was conducted with licensee.

Site visit notice posted. And Licensee advised to keep notice posted for 30 days or a civil penalty of $100 will be assessed.
Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3