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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020772
Report Date: 04/27/2021
Date Signed: 05/03/2021 03:06:12 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
198020772
ADMINISTRATOR:ROSA MENDOZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 447-8147
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY:14CENSUS: 3DATE:
04/27/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Rosa MendozaTIME COMPLETED:
05:05 PM
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Licensing Program Analysts (LPA) Cynthia Reyes conducted an announced Change of Location pre-licensing inspection in English on this date. Due to COVID-19, precautionary measures were taken by the LPA and all individuals present during the entire inspection. All individuals wore appropriate personal protective equipment. LPA met with applicant Rosa Mendoza who confirmed the family members residing in the home, that consists of 1 adult and 3 children. The applicant is requesting a Large (14 Capacity) family child-care home license. Per Applicant, operating hours will be Monday to Friday, 8AM to 2PM.

At 3: 05 PM LPA began the tour of the home with the applicant beginning at the front door to the home. Applicant stated during Covid-19, no parents are allowed inside the home and children health checks which include temperature being taken and hand sanitizer used to clean hands will be conducted at the entrance door to the day care room located in the converted garage. Parents will enter the side gate of the home and drop children off where the door is located for the day care room. The front yard is off limits. At the front door to the home is a bedroom to the left of the entrance which is off limits to the day care and LPA observed the applicants own 2 children. To the right of the front door is a small hallway where LPA observed two other bedrooms that are off limits and LPA observed applicants one other child in one of the rooms and both rooms doors were closed. The bathroom in this hall way will be used by the children and LPA did not observe any hazardous items accessible to the children. LPA observed in the bathroom the hand washing Covid-19 posters at children's eye level. 3:35 PM, the living room with an open dining area was the next room inspected that the children will have access to and where the applicant tested the smoke detector and carbon monoxide and was heard by the LPA to be working properly. The tour continued threw the kitchen and the applicant open drawers and cabinet doors to show LPA, who did not observe any hazardous items such as poisons, toxins or sharp items to be accessible to the children in care. Next to the off limit kitchen is the off limits laundry area that was also observed not to have any hazardous items accessible. Continue on next page

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021
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 5
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: 198020772
VISIT DATE: 04/27/2021
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Page 2 Continued

3:45 PM Walk threw continued from the laundry area door to the back yard where on the left side is the converted Garage that the applicant states she will use for activity space only. LPA had applicant document on a declaration that the converted garage will not be used for eating or sleeping. LPA observed a parent board inside the activity room/garage with all the posting requirements from the department. Around the room LPA observed several of the Covid-19 documented posted at children eye level. This room also has a working smoke detector, carbon monoxide, and fire extinguisher that was served 04/2021. LPA observed a large first aid box on the wall with all the required supplies that included a baby thermometer. Outside the garage where the parents will enter the side gate from the front yard had another parent board with all Covid-19 documents. The rest of the back yard will be used for the children which LPA observed age appropriate toys, grass for cushion a covered patio for shade and a place to eat.

The home was inspected for safety, comfort, cleanness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Per applicant there are no weapons or firearms currently in the home. LPA observed there are age appropriate toys and napping equipment. Applicant owns the home. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas.

The areas observed by the LPA were confirmed by the applicant during the inspection and have been documented as followed:

Off limits areas that include: 3 Bedrooms, Kitchen, laundry area and front yard. **Rooms that are off-limits need to be made inaccessible during operating hours** The applicant does understand that licensing staff may have access to off-limit areas during the inspection if necessary.

The areas used by children include: Living room, Dinning area, Bathroom, converted Garage/Play room and the back yard.

The applicant states that she will provide food for children in care. Licensing staff advised that if children bring food or drinks from home that it should be properly labeled.
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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: 198020772
VISIT DATE: 04/27/2021
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The applicant has completed the required Health and Safety Training with Nutrition on 10/07/2018. Pediatric First Aid and CPR, Exp. on 09/18/2019. The applicant has completed the required Mandated Reporter Training on 04/20/2021

4:05 PM The following was discussed with the applicant:
-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. Civil Penalty will be assessed if not in compliance.
-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated with the facility license.
-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
-Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated.
-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes, and/or if you move from your home.
-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone (no voice mail) and within seven (7) days in writing. (use LIC624B for written report)
-Fire and safety drills must be performed every six months and documented for review by the Department.
-Smoking is prohibited in a family child care home.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
- 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.
- Licensees shall reveal each facility license number on all advertisements, publications, or announcements with the intent to attract clients
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: 198020772
VISIT DATE: 04/27/2021
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Page 4 Continued

-All adults living and working in the home shall be made aware of the Department's right to inspection authority, which includes but is not limited to the right to enter the home when children are being cared for, interview children and adults, and review documentation.
- Emergency Disaster Plan, Parent’s Rights Poster, and the Facility License are required to be posted
- Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

· Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information. Per Applicant she will carry liability insurance or a bond in accordance with the standard established by the Family Child Care statute. Signed statements (LIC 282) will be in the children’s files. The law requires a Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file.

· Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunization's.

· Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

Medication: 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm



4:40 PM LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. Applicant’s email address is on file. The applicant was advised that the email may be public information.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 198020772
VISIT DATE: 04/27/2021
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Page 5 Continued

Infant Care: LPA advised the applicant to sleep infants where they can be directly supervised at all time. LPA advised against sleeping infants in a separate room. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe sleep concepts were provided. LPA discussed PIN 20-24-CCP

Licensee was advised to review the Department’s training videos at https://ccld.childcarevideos.org/ which will assist in increasing their understanding in the Department’s role in protecting the health and safety of children in their care.



The licensee was informed of The Child Care Advocate Program (CCAP) Direct contact information is as followed: Phone number: (916) 654-1541 Email Address: childcareadvocatesprogram@dss.ca.gov

4:50 PM LPA also consulted with the applicant regarding COVID-19 health and safety guidelines on this date. Applicant was provided forms to post via email. Licensing staff observed COVID- 19 postings posted in different areas of the day care on this date. During this inspection LPA also discussed PIN 20-06 CCP, Social and Physical Distancing Guidance and Healthy Practices for Child Care Facilities in Response to The Global Corona virus (COVID-19) Pandemic Written in Collaboration with The California Department of Education. LPA reviewed with the applicant the Child Care Covid-19 Self-Assessment guide the applicant filled out and Emailed to the LPA on this 04/20/2021.

The application will be submitted to be licensed after completion of correction needed (Copy of home Ownership & Lead training). Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. At that time, the applicants home will meet the description of a safe and healthy environment for children as described in Chapter 1, Division 12, Title 22 of the California Code of Regulations, and will be submitted for approval to be licensed as a large (14) Family Child Care Home.

5:05 PM The exit interview was conducted with Rosa Mendoza. This report along with a copy of the appeal rights will be sent to the applicant via email with a read receipt or confirmation of receipt of the email, which will act as the Licensee’s signature

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5