198019676-8-30-2019-54-CC-RNAO-BFJQKS-20190830121448

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019676
Report Date: 08/30/2019
Date Signed: 08/30/2019 12:14:56 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 CARE		FACILITY NUMBER:	198019676
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	08/30/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Sara Mendoza		TIME COMPLETED:	12:30 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	A Case Management Inspection was conducted by Licensing Program Analyst (LPA) Raul Navarro in Spanish. The Licensee is requesting a change of capacity to 14 children. LPA was guided on a tour of the facility by Licensee Sara Mendoza. There were three children present during today's inspection. This is a single story home with three bedrooms and two bathrooms. Residing in the home are three adults (Criminal Record Clearance on file), and three children. Fire Clearance was granted on 07/24/19. Areas accessible to children were inspected as follows: One bedroom, one bathroom, living room, dining room, kitchen, and front porch (fenced). Areas off limits include: Two bedrooms and one bathroom. The Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary. There is a community pool There is a community pool located 55 feet from the applicant's home. Applicant has an alarm system that is activated when the front or back door of the home are opened. Applicant stated she has added the alarm system as another security precaution for the children in care. The front entrance is surrounded by a gate. As per applicant the pool is maintained closed and is only opened during the summer months. LPA inspected the pool area and did not observe any person in the pool area. 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. Licensee states that there are no weapons, firearms on the premises.There were no wall heaters observed in the home. The home has central air. The front porch is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors and carbon monoxide detector are in operable condition.The valve on the required 2A 10BC fire extinguisher indicates fully charged, last serviced on 03/2019. 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: 08/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019

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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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: 08/30/2019

NARRATIVE

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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. LPA will recommend the increase in capacity as the Licensee meets the requirements for an increase.

After further review by the department, Licensee will be notified if/when License is granted. Once licensed, the Licensee is required to adhere to the terms and limitation as stated on the license.

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.

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: 08/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019

LIC809 (FAS) - (06/04)

Page: 3 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: 08/30/2019

NARRATIVE

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All rooms that are off-limits are inaccessible. Storage areas for poisons, detergents, cleaning compounds, medicines, and other items which pose a danger to children were observed to be inaccessible. LPA observed the home to be kept clean and orderly, with heating and ventilation for safety and comfort.

The Licensee has current Pediatric First Aid and CPR, which will expire on 03/2021. Proof of immunization against influenza, pertussis, and measles for the Licensee was readily available and reviewed by the LPA. The Licensee has also taken the required Mandated Reporter Training.

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

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.

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. Role and responsibilities of being a Mandated Reporter were reviewed. 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.

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: 08/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019

LIC809 (FAS) - (06/04)

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