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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019676
Report Date: 11/15/2019
Date Signed: 11/15/2019 02:22:57 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: DATE:
11/15/2019
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sara MendozaTIME COMPLETED:
02:10 PM
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An office meeting was conducted today in the Monterey Park South West Regional Office in Spanish. Present at the meeting was Licensee, Sara Mendoza, Licensing Program Manager Karen Chambers and Licensing Program Analyst Raul Navarro.

The purpose of this meeting is to discuss the application for capacity increase to 14 children. The community in which the licensee lives has a pool that has a chain link fence with openings that are more than two inches. The department is granting the capacity increase under the following conditions:

1. The pool will not be used by the children in care at any time.
2. There should be audible door alarms that can be heard throughout the home.
3. Alarms are to be tested daily and documented.
3. There will be direct visual supervision at all times when children are outside.

The Licensee Sara Mendoza is in agreement the above terms.

During today’s discussion, the licensee was reminded that it is their responsibility to ensure compliance with the Title 22 regulatory requirements and the California Health & Safety code at all times.

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



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

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
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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