198019676-2-21-2020-54-CC-RNAO-BLZVHC-20200221152654

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019676
Report Date: 02/21/2020
Date Signed: 02/21/2020 03:27:05 PM

COMPREHENSIVE INSPECTION

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	MENDOZA FAMILY CHILD CARE		FACILITY NUMBER:	198019676
ADMINISTRATOR:	SARA MENDOZA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 341-9616
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	14	CENSUS: 7	DATE:	02/21/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:36 PM
MET WITH:	Sara Mendoza		TIME COMPLETED:	03:50 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	Licensing Program Analyst (LPA) Raul Navarro conducted an 1 year required inspection in Spanish. LPA met with Licensee Sara Mendoza who guided this LPA on a tour of the facility. Also present was Licensee's assistant (criminal record clearances on file). There were seven children present during today’s inspection. Licensee states that there are currently nine children enrolled. The children's roster was reviewed and is current. Disaster drill log was also available during today’s inspection. Last drill conducted in February 2020. This is a one story manufactured home which consists of 3 bedrooms and 2 bathrooms. Areas used by the children include the living room, dining room, kitchen, one bedroom, one bathroom, and front patio. Per Licensee, areas off limits to children and parents include: two bedrooms and one bathroom. There is a community pool located 55 feet from the Licensee's home. Applicant has an alarm system that is activated when the front or back door of the home are opened. Licensee test the alarm daily and keeps a log of the test. There is a gate preventing access to the entrance/exit of the home. As per applicant the pool is maintained closed and is only opened during the summer months. The main door is locked with a chain to prevent access to the pool area. LPA did not observe any alterations to the pool area. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone maintained in the home. Family members residing in the home are three adults (criminal record clearances on file) and three children. There are no pets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible.Licensee states there are no poisons in the home. Report continues- Page 1 of 3

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 198019676
	VISIT DATE: 02/21/2020

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
26
27
28
29
30
31
32

Per Licensee, there are no weapons or firearms in the home. There are safe toys, play equipment and materials observed for children. The Emergency Disaster Plan was posted at the time of inspection. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The valve on the required 2A 10BC fire extinguisher indicates fully charged, last serviced on 03/12/2019. Smoke and carbon monoxide detector was tested and is in operable condition.

The Licensee and Assistant have current Pediatric First Aid and CPR, which will expire on 08/2021 for the Licensee and 2/2022 for the Assistant. Proof of immunization against influenza, pertussis, and measles for the Licensee and her Assistant was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training. Assistant has not taken the training due to it not being available in Spanish.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

Rooms that are off-limits need to be made inaccessible during operating hours. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. A hard copy of A Child Care Provider’s Guide to Safe Sleep was provided.

Report continues- Page 2 of 3

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 198019676
	VISIT DATE: 02/21/2020

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
26
27
28
29
30
31
32

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

LPA issued the Confidential Names List (LIC 811) to the licensee during this visit. The Confidential Names List documents the children’s files that were reviewed during this inspection.

At this time, the Licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview was conducted with Licensee Sara Mendoza. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Report ends- Page 3 of 3

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

LIC809 (FAS) - (06/04)

Page: 3 of 3