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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500085
Report Date: 10/08/2021
Date Signed: 10/08/2021 03:16:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:MENDOZA, ALMAFACILITY NUMBER:
344500085
ADMINISTRATOR:MENDOZA, ALMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 513-7089
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:14CENSUS: 3DATE:
10/08/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Alma MendozaTIME COMPLETED:
03:30 PM
NARRATIVE
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On 10/08/21 Licensing Program Analyst (LPA) Fabiola Diaz met with licensee Alma Mendoza for unannounced annual inspection. Present in the facility was licensee’s husband and two adult daughters. When entering the facility, LPA observed 2 day care children and one infant present.

The home has an fenced front yard, 5 bedrooms, 2 bathrooms, living room, kitchen, dining area, garage, laundry room, and fenced backyard. The off-limits areas all bedrooms, garage, laundry room, and sides of backyard. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. Licensee acknowledges that children may never enter these off-limit areas. Licensee was notified that prior to use of any off limits area, the department must be notified.
A health and safety inspection was conducted in the areas accessible to children. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. The first aid kit is located in the laundry room. Licensee stated she has no weapons in the home. No bodies of water were observed within the facility. Cleaning compounds and hazardous items were inaccessible to children. Safe toys and play equipment were observed. LPA discussed and observed all the required postings. The home has a fireplace that is barricaded meeting Title 22. LPA advised the applicant that if there are any poisons at the home, all poisons must be locked with a key lock or combination lock.

LPA observed did not observe record of licensee’s immunization in facility, and licensee stated she didn't have current copies and would acquire them from her medical provider. Children's roster and fire drill log were observed. Licensee had CPR/First aid card, but was not EMSA approved. LPA discussed the Mandated Reporter Training and informed that it is now in Spanish, and licensee stated she is currently still working on completing it. Licensee understands training must be complete every two years.
Report continues on 809C................
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
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 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MENDOZA, ALMA
FACILITY NUMBER: 344500085
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, as licensee did not have current EMSA approved pediatric CPR/First Aid, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2021
Plan of Correction
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Licensee stated she will complete the EMSA approved pediatric CPR/First Aid and provide a copy of the certificate to LPA.
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: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2021
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: MENDOZA, ALMA
FACILITY NUMBER: 344500085
VISIT DATE: 10/08/2021
NARRATIVE
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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

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.

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.

Licensee was reminded that all adults 18 and over, 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.

Title 22 Deficiency was observed and is documented in the following LIC809-D. Two Advisory Notes were assessed today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Alma Mendoza.

SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
LIC809 (FAS) - (06/04)
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