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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843238
Report Date: 04/06/2023
Date Signed: 04/06/2023 11:28:07 AM


Document Has Been Signed on 04/06/2023 11:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
334843238
ADMINISTRATOR:CECILIA MENDOZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 698-2650
CITY:COACHELLASTATE: CAZIP CODE:
92236
CAPACITY:14CENSUS: 5DATE:
04/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Cecilia Mendoza ValenciaTIME COMPLETED:
11:45 AM
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On 04/06/2023, Licensing Program Analyst (LPA) Lorena Valenzuela arrived at the facility to conduct an annual inspection as part of a compliance review. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed:

• Normal days and hours of operation are: Monday through Friday 5:30 am-6:30pm
• Off-limit areas include: garage, all bedrooms and laundry room
• The facility is licensed to have no more than 14 children as a large family child care home and is operating within the licensed capacity and appropriate ratios.
• Appropriate supervision provided during this inspection
• A working telephone is present, and the current phone number is on file
• A fully charged fire extinguisher was observed. A smoke detector and carbon monoxide detector were present and tested by the Licensee during this inspection.
• There is no fireplace in the home
• All hazardous items are stored inaccessible to children
• Toxins are locked
• Weapons are present and are not stored ( in an off limit area) according to Title 22. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations.
• This is a one story home
• Clean, safe and age appropriate toys
• Current roster on file
• Facility Sketch, Emergency Disaster Plan and Notification of Parent’s Rights poster are posted
• Documentation of fire and disaster drills on file – Last drill conducted on 02/08/2023.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Lorena ValenzuelaTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023
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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 334843238
VISIT DATE: 04/06/2023
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No bodies of water at this time. Licensee 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.
Verification of control of property on file
• Children’s records are complete
• Employee’s records are complete
• Mandated Reporter Training was completed by assistant and licensee.
• Pediatric CPR and First Aid Card expire on 03/2025
• Health & Safety Certificate - completed on 05/04/2015
• Resident and/or staff records were reviewed and all adults who require caregiver background checks have received all required clearances and/or exemptions.
The licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.
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 Licensee was informed of their reporting requirements and was provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov
LPA discussed the safe sleep regulations with licensee 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 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.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Lorena ValenzuelaTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 334843238
VISIT DATE: 04/06/2023
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Licensee 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.
Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.

The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.

There was deficiency issued, see LIC 809- D report.

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/inspection-process.
An exit interview was conducted, and this report was reviewed with the licensee Cecilia Mendoza. Appeal rights were discussed and provided during the exit interview.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Lorena ValenzuelaTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 04/06/2023 11:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501


FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 334843238

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)(C)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (C) Ammunition shall be stored and locked separately from firearms.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in that there is firearms and ammunition stored in an area that is off limits and the ammunition is not stored and locked seperately from the firearms, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
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Licensee agrees to submit proof of correction, documentation of appropriate storage of firearms and ammunition to the Department by due date 04/14/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Deborah MullenTELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Lorena ValenzuelaTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023
LIC809 (FAS) - (06/04)
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