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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274403637
Report Date: 05/02/2024
Date Signed: 05/02/2024 02:59:53 PM


Document Has Been Signed on 05/02/2024 02:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:MENDOZA, MARIAFACILITY NUMBER:
274403637
ADMINISTRATOR:MENDOZA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 905-3681
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY:14CENSUS: 3DATE:
05/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Maria MendozaTIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual inspection to the home today. LPA met with Maria Mendoza, Licensee, and explained the nature of today's inspection to her.
Days and hours of operation are Monday to Saturday from 5:00 AM to 6:00 PM. The adults that reside in the home are Licensee, and her son Jose Manuel. Also licensee minor 14 years old daughter. LPA observed 1 school age child in care at arrival and 2 more arrived during the inspection. Licensee's CPR and First Aid Certification is current and will expire on 4/11/26.
LPA toured the indoor and outdoor areas of the home during today's inspection. LPA took a picture of the Child Care Facility Roster during today's inspection and it is current. LPA reviewed 5 children's files and are current. LPA reviewed the Fire/Disaster drill log during today's visit and it is not current. Last fire drill was documented on 12/08/23. The Licensee has a working telephone in the home.
LPA observed sufficient materials, toys, and play equipment for the day care children. Off limit areas in the home are: Five bedrooms, and two bathrooms. There are not stairs in the home. Off limits out side are the left and right side yards. LPA observed the home has a back yard and it is fenced. Licensee uses the back as playground. LPA observed a trampoline in the backyard. Licensee understands that only one child at a time is allowed to play in the trampoline and shall follow manufacturer's instructions.
LPA observed a fully charged 2A10BC fire extinguisher, working smoke detectors and no bodies of water. LPA observed a working carbon monoxide detector in the home. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.
LPA observed licensee has in file for herself the required proof of immunization for pertussis, influenza and measles according with the SB792.
Licensee has completed the Mandate Reporter training on3/05/23 and it is current, Licensee was advised that all adults in contact with children are required to complete the "mandated reporter" training. Licensee was reminded the training is to renew every two years. LPA referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training.

Report dated 5/02/24 continues in page 2
SUPERVISOR'S NAME: Susy CervantesTELEPHONE: (408) -32-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MENDOZA, MARIA
FACILITY NUMBER: 274403637
VISIT DATE: 05/02/2024
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Report dated 5/02/24 continues from page 1.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a helper must be present. Licensee understands that in absence of a helper her license capacity is reduced to only 8 children. Licensee stated she transports children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.

A review of staff records on 4/30/24 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee Maria Mendoza was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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

Exit interview conducted and report was reviewed with the licensee's mother Alicia Mendoza.

No deficiencies were cited today.

A notice of site visit was given and must remain posted for 30 days

SUPERVISOR'S NAME: Susy CervantesTELEPHONE: (408) -32-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC809 (FAS) - (06/04)
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