334845158-12-11-2019-09-CC-DHOE-BJRPF2-20191211101601

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334845158
Report Date: 12/11/2019
Date Signed: 12/11/2019 10:16:14 AM

COMPREHENSIVE INSPECTION

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:	MENDOZA FAMILY CHILD CARE		FACILITY NUMBER:	334845158
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	12/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Licensee Guadalupe Mendoza		TIME COMPLETED:	10:20 AM

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 12/11/2019 at 8:45am, Licensing Program Analyst Destinee Hogue arrived at the facility to conduct unannounced random inspection. The licensee has applied to increase her capacity to that of a Large Family Child Care Home. Present during this inspection were LPA Hogue, Licensee Guadalupe Mendoza, Licensee Manuel Mendoza and Licensee’s son Michael Ruiz. LPA toured the facility inside and out, reviewed records and discussed the following with Licensee Guadalupe Mendoza: · Normal days and hours of operation are: Monday through Thursday, 7:00am to 6:00pm and Friday, 7:00am to 5:00pm. · OFF-LIMIT AREAS INCLUDE: ENTIRE SECOND FLOOR AND GARAGE · Appropriate fire extinguisher, smoke detector and carbon monoxide detector are present and were tested by licensee during this inspection. · All hazardous items are inaccessible · Toxins and poisons are locked · No guns or weapons present as of this date. LICENSEE UNDERSTANDS ALL GUNS, WEAPONS AND AMMUNITION MUST BE KEY-LOCKED SEPARATELY AND MADE INACCESSIBLE PER TITLE 22 REGULATIONS. · Stairs are barricaded · Verification of control of property on file (deed of trust) · Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights forms are posted · Pediatric CPR and First Aid Card expires on 08/2020 · Health & Safety Certificate completed on 08/26/2018 · AB1207 Mandated Child Abuse Reporter training completed 09/13/2018

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee Hogue	TELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

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 5

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: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 334845158
	VISIT DATE: 12/11/2019

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

· There are no bodies of water as of this date. 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.
· Clean, safe and age appropriate toys are available for children in care
· There are no toxic plants observed at this time
· Current roster on file
· Documentation of fire/emergency disaster drills on file. Last emergency disaster drill conducted on 11/05/2019
· Children’s and Employee’s records were reviewed and complete
· 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.
Resident and/or staff records reviewed on 12/11/2019 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279, LIC508 and TB Screen and have your child submit for LIVESCAN background clearance. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.
· 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
· For more information on SIDS and Safe Sleep Environments, please visit:

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee Hogue	TELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 334845158
	VISIT DATE: 12/11/2019

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

California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Risk-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

The following was reviewed with Licensee’s on 10/04/2018. Licensee Guadalupe Mendoza provided proof of LIC809 Facility Evaluation Report during this inspection:
- SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016 – Please refer to Facility Evaluation Report (LIC809, page 3) for definition of SB277.
- AB290 – Child Nutrition, effective January 1, 2016 - Please refer to Facility Evaluation Report (LIC809, page 4) for definition of AB290.
- SB792 – Immunization requirements for staff, volunteers, effective September 1, 2016 – Please refer to Facility Evaluation Report (LIC809, page 4) for definition of SB792.
- AB2231 (2016) – Increased Civil Penalties, effective July 1, 2017 – Please refer to Facility Evaluation Report (LIC809, page 4) for definition of AB2231.
- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – Please refer to Facility Evaluation Report (LIC809, page 4) for definition of AB1207.
- AB2370 – Effective January 1, 2019 – Lead Poisoning – Providers are required to provide a lead toxicity prevention handout to parents/guardians of newly enrolled and newly reenrolled children with information on risks and effects of lead poisoning; blood lead testing recommendations and requirements; and options for obtaining blood lead testing, including free and/or discounted testing. There will be a training component of this added to the Preventative Health Training beginning July 1, 2020. A copy of Lead Exposure Brochure was provided to Licensee Guadalupe Mendoza during this inspection.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee Hogue	TELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 334845158
	VISIT DATE: 12/11/2019

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

- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov
The following documents were provided to Licensee Guadalupe Mendoza during this inspection:
1) Fall 2019 Quarterly Update
2) 2019 Safe Sleep Brochure
3) Effects of Lead Exposure Brochure
4) Provider Information Notice (PIN) 19-16-CCP United States Consumer Product Safety Commission (CPSC) Urges Consumers not to use inclined Infant Sleep Devices
5) PIN 19-14-CCP Adverse Childhood Experiences and Trauma-Informed Care in Child Care Facilities
Responsibility of a Licensed Family Child Care Provider:
- Access to forms & Regulations for Family Child Care Homes online at www.ccld.ca.gov
- Responsibility to know the regulations for anyone providing care
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility’s phone numbers must be on file at all times.
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months
- Responsibilities of being a mandated reporter
- Baby walkers, bouncy seats, exersaucers and other similar items are prohibited
- The applicant is urged visit the U.S. Consumer Product Safety Commission webpage at www.cpsc.gov to ensure that equipment purchased for the day care has not been recalled
- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
Receive Department of Social Services updates by subscribing to www.ccld.ca.gov. Click on “RECEIVE IMPORTANT UPDATES”, select Child Care Advocate Program and enter contact information.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee Hogue	TELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 334845158
	VISIT DATE: 12/11/2019

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

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

A Confidential Names List was completed and provided to the applicant during this inspection.

The application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12, or 14 children with parent notification.

During the exit interview, Licensee Guadalupe Mendoza, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS. A copy of this report was provided to the Licensee on 12/11/2019 and must be made available to the public upon request for the next 3 years.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee Hogue	TELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

LIC809 (FAS) - (06/04)

Page: 5 of 5