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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019676
Report Date: 09/26/2019
Date Signed: 09/26/2019 03:07:01 PM

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 CAREFACILITY NUMBER:
198019676
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
09/26/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Sara MendozaTIME COMPLETED:
03:26 PM
NARRATIVE
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Licensing Program Analyst (LPA) Raul Navarro conducted an announced case management inspection in Spanish. LPA met with applicant, Sara Mendoza who guided LPA on a tour of the facility. Also present was Licensee's Assistant. There was a total of five children present during today's inspection.

There is a community pool located 55 feet from the applicant's home. Applicant has installed an alarm system that is activated when the front door or back door of the home are opened. LPA tested the door alarms and they are in operable condition. Applicant stated she has added the alarm system as another security precaution for the children in care. LPA took pictures of the enclosed car port. Licensee has a baby gate that prevent day-care children from leaving the car port.

LPA took measurements of the pool. The chain link fence is 5 feet high and in good repair surrounding one side of the pool. The chain link fence provides a view to the pool. The gate swings away from the pool, is self latching, and self closing. LPA measured the width of the openings in the chain link fence and took pictures as well. Chain link fence openings exceed 1 3/4 inches. There are 2 sides of the pool surrounded by a concrete wall, and both sides measure 5 feet high. One side of the concrete wall is along the street side and the other side is along the driveway. The last side of the pool is adjacent to a building.

LPA Navarro advised the Licensee that she will have to submit a waiver due to the chain link fence openings exceeding 1 3/4 inches. Licensee was notified that her request for a large license will be contingent upon a managers approval and waiver approval.

Exit interview was conducted with the Licensee. Appeal rights were provided. 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.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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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