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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844571
Report Date: 09/29/2021
Date Signed: 09/29/2021 10:28:27 AM

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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MEJIA FAMILY CHILD CAREFACILITY NUMBER:
334844571
ADMINISTRATOR:MEJIA,LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 206-3496
CITY:CALIMESASTATE: CAZIP CODE:
92320
CAPACITY:14CENSUS: 4DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:32 AM
MET WITH:Licensee, Laura MejiaTIME COMPLETED:
10:35 AM
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On 09/29/2021 at 07:32am, Licensing Program Analyst (LPA) Destinee Hogue arrived at the facility to conduct a required annual inspection. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed with Licensee, Laura Mejia:

Normal days and hours of operation are: Monday through Friday from 4:30am to 4:30pm
OFF-LIMIT AREAS INCLUDE: Backyard, right side of the house, Master Bedroom, Bedrooms 1 & 2, Bathroom #2 and Second Kitchen

- ZERO TOLERANCE: No bodies of water observed at the time of this inspection. 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.
- ZERO TOLERANCE: 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.
- Storage areas for poisons are observed to be inaccessible and stored behind a key-locked cabinet.
- All hazardous items are inaccessible, this includes; detergents, cleaning compounds, medications, and other items.
- Residence does not have a fire place
- Appropriate fire extinguisher, smoke detector and carbon monoxide detector are present and were tested by the applicant during this inspection.
- Home is clean and orderly, with heating and ventilation for safety and comfort
- Facility is a single-story residence
- Safe and appropriate toys and equipment are present for both indoor and outdoor activities.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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 4
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MEJIA FAMILY CHILD CARE
FACILITY NUMBER: 334844571
VISIT DATE: 09/29/2021
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- A working telephone is present
- The home shall be kept clean and orderly, with heating and ventilation for safety and
comfort.
- ZERO TOLERANCE: The Licensee shall be present in the home and shall ensure that children in care are supervised at all times.
- When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children.
- ZERO TOLERANCE: Children shall not be left in parked vehicles.
- Outdoor play areas are fenced, and appropriate supervision was observed at the time of this inspection.
- The facility is operating within the licensed capacity and appropriate ratios were observed at the time of this inspection.

NEW Safe Sleep Regulations (Effective September 15, 2020):
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 [facility representative] 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.
- During this inspection, LPA Hogue provided a copy of Provider Information Notice (PIN) 20-14-CCP - New Safe Sleep Regulations

Facility Records Review:
- Each child’s file contains a copy of the emergency information card with required information
- Pediatric CPR and First Aid Card expires on 02/2023
- AB 1207 Mandated Child Abuse Reporter Training completed on 10/18/2020
- Documentation of emergency disaster drills on file. Emergency disaster drill completed on 05/13/2021
- Review of staff records contain proof staff are immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year or provide a statement denying the influenza vaccination.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MEJIA FAMILY CHILD CARE
FACILITY NUMBER: 334844571
VISIT DATE: 09/29/2021
NARRATIVE
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- The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

- 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.

- 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.

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

Exit interview conducted and report was reviewed with the Licensee Laura Mejia.

SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MEJIA FAMILY CHILD CARE
FACILITY NUMBER: 334844571
VISIT DATE: 09/29/2021
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- ZERO TOLERANCE: The Department shall notify a Licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons. The Licensee shall comply with the notice.
- Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed. All individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. This was verified on 09/29/2021.

- ZERO TOLERANCE: 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.

- 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

- Licensee understands each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the Licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

- The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

- The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

- The Duty Officer is available to answer questions Monday – Friday from 8:00am to 5:00pm at (951)782-4200
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
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