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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203908535
Report Date: 07/24/2019
Date Signed: 07/24/2019 05:44:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:BRAVO DE MENDOZA, LIDIA FAMILY CHILD CAREFACILITY NUMBER:
203908535
ADMINISTRATOR:BRAVO DE MENDOZA, LIDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 673-7023
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY:14CENSUS: 6DATE:
07/24/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lidia Bravo De MendozaTIME COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Angelica Slaughter conducted an unannounced Annual/Random inspection. LPA met with Licensee Lidia Bravo De Mendoza. Also present was Licensee's husband and family. LPA conducted a tour of the home as shown on the facility sketches (LIC 999A) provided. Accessible areas of the home are the two living rooms, dining room, kitchen, hallway bathroom, bedroom at end of hall and back yard. All other rooms in the home are made inaccessible by spinner knob covers or locked doors. Two large dogs were observed in a dog pen, making them inaccessible to children in care. Licensee understands she is responsible for the children's safety around any pets. There are no "bodies of water". There are no firearms in the home. No poisons were observed on the premises. There is a screened fireplace making it inaccessible to children. There are no stairs in the home. There is a working fire extinguisher, smoke detector, carbon monoxide indicator and adequate heating and ventilation for safety and comfort. There is a working telephone (559) 673-7023 and number was verified. Adequate supervision is being provided during this inspection. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunization for pertussis, measles and influenza for herself and her assistant. Fire drills are conducted every six months. Licensee is aware that children are never to be left in parked vehicles. One adult who resides in the home is not cleared, however, all other adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care. Licensee’s Pediatric CPR/First Aid expires 06/19/21. Licensee has not completed AB 1207 Mandated Reporter Training. Licensee will complete required training once it is available in Spanish. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. Licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address. Days and hours of operation are Monday – Saturday; 4:00 AM – 6:00 PM and as arranged.

Continued on 809-C

SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: BRAVO DE MENDOZA, LIDIA FAMILY CHILD CARE
FACILITY NUMBER: 203908535
VISIT DATE: 07/24/2019
NARRATIVE
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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 provided Licensee with information regarding the California Department of Social Services (CDSS) Provider Information Notices (PINs) communication system; AB 2370, Chapter 676, Statutes of 2018, requiring child care providers to inform parents and/or guardians with lead safety information, and other important resources and information links offered on the CDSS website. LPA also discussed safe sleep with Licensee.



Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC809-D) Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Licensee was provided a copy of appeal rights, a copy of this report, as well as form LIC 9213. Site Visit Notice to be posted on the parent board.



THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019
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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BRAVO DE MENDOZA, LIDIA FAMILY CHILD CARE
FACILITY NUMBER: 203908535
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/26/2019
Section Cited
CCR
102370(d)(1)
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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not
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Licensee stated she will have son re-printed for clearance immediately. Licensee will submit proof of submission of clearance request to CCL by the POC due date of 07/26/19.
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met as evidenced by today's inspection. Licensee's adult son is not finger print cleared. Licensee provided proof of payment to Livescan and completed Livescan form, however, he was not showing cleared on system. This posses an immediate risk to the health, safety and/or personal rights of children in care. Licensee is subject to a $100 civil penalty that will be accessed immediately.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3