<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334817343
Report Date: 05/12/2022
Date Signed: 05/12/2022 03:39:43 PM


Document Has Been Signed on 05/12/2022 03:39 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
334817343
ADMINISTRATOR:MENDOZA, PETRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 698-2341
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:14CENSUS: 6DATE:
05/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Licensee Petra MendozaTIME COMPLETED:
03:50 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
On 05/12/2022 at 11:30 AM Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct an annual inspection. LPA was granted entry by Licensee’s Assistant Marie Medina. LPA toured the facility, inside and out, reviewed records, and observed and/or discussed the following: The licensee had an accident and is only operating at a capacity of 6 to 8 children, with a qualified assistant Listed as Staff 1 or (S1). A COVID-19 Survey was conducted and no concerns at this time.

Normal days and hours of operation are: Monday- Friday, 7:30 AM to 5:30 PM

OFF-LIMIT AREAS INCLUDE: Entire 2nd Floor, Garage.

The inspection consisted of reviews of the following domain: Physical Plant, Care and Supervision, Records, Facility Administration, Staffing Ratio and Capacity, Personal Rights The inspection found the facility to be in compliance in these domains, except as noted on the LIC809D. Deficiencies not cited this visit.

· The facility is operating within the licensed capacity and appropriate ratios on 05/12/2022


· The Licensee is present in the home and has ensured that children in care are supervised.
· When temporarily absent from the home, the Licensee Petra Menoza, shall arrange for a substitute adult to care for and supervise children
· A working telephone is present.
· Appropriate fire extinguisher, smoke detector and carbon monoxide detector are present and were tested by the Licensee Petra Mendoza during this inspection on 05/12/2022.
· All hazardous items are inaccessible, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children.
· Storage of poisons is inaccessible to children and locked
· There is a properly barricaded fireplace 05/12/2022
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Susan BrewerTELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 334817343
VISIT DATE: 05/12/2022
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
26
27
28
29
30
31
32
· No guns or weapons present as stated by the Licensee. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· Stairs are barricaded on 05/12/2022
· Home is clean and orderly, with heating and ventilation for safety and comfort.
· Safe and appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas are fenced and/ or appropriate supervision is present.
· Verification of control of property on file by deed of trust.
· Pediatric CPR and First Aid Training Completed 09/12/2020 and Card expires on 09/2022
· Health & Safety Certificate - completed on 05/28/2006
· Mandated reporter: General: NOT ON FILE; Child Care Expires: NOT ON FILE
· Fire clearance: 04/18/2006 Documentation of fire & earthquake drills to be conducted every six months: Last drill on 02/10/2022 with 4 children in care, at 9:30 AM to 10:00 AM, exited to the front yard.
· There are no bodies of water on 05/12/2022. Licensee Petra Mendoza, understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Clean, safe and age appropriate toys
· Children’s files are NOT complete on 05/12/2022, Child 4 listed on the LIC857 Confidential Names list did not have a LIC9227 Infant Safe Sleep Plan or Infant Safe Sleep Log on file, when LPA conducted a review of C4's records.
· Staff Records are NOT complete on 05/12/2022, as Staff 1 did not complete the Mandated Reporter Training as required by the Health and Safety Code.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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.

SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Susan BrewerTELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 334817343
VISIT DATE: 05/12/2022
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
26
27
28
29
30
31
32
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

Licensee Petra 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 Susan Brewer, discussed the safe sleep regulations with licensee Petra Mendoza, and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA S.Brewer, 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

No Civil Penalties were issued in today's visit.

No citations were issued in today's visit.

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

Exit interview conducted and report was reviewed with the licensee Petra Mendoza and Staff 1 Marie Medina, who signed on behalf of the licensee. A copy of the report was provided to the licensee Petra Mendoza on 05/12/2022.

SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Susan BrewerTELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3