364806069-9-23-2021-12-CC-DMAX-C75VMC-20210923163319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364806069
Report Date: 09/22/2021
Date Signed: 09/23/2021 04:33:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	MELLADO FAMILY CHILD CARE		FACILITY NUMBER:	364806069
ADMINISTRATOR:	MELLADO, SALLY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 887-8498
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92407
CAPACITY:	14	CENSUS: 1	DATE:	09/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:11 PM
MET WITH:	Sally Mellado		TIME COMPLETED:	03:00 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	Licensing Program Analyst (LPA), Maddox met with with licensee, Sally Mellado today for the purpose of conducting and unannounced 1 yr- Annual/Random inspection. Present today was licensee and 1 day care child. This is a 2 story home (barricade in place on stairs) with 4 bedroom, 3 bathrooms. Family members residing in the home include licensee, her adult daughter and 4 grandchildren. LPA verified all adults in the home have fingerprint clearances and exams for T.B. (licensee also has required immunization's). Main areas of care are conducted in the family room (located next to kitchen), living room, and another dining area part of the living room. Children use the bathroom in hallway. Off limit areas include all upstairs. Licensees hours of operation are Mon - Fri from 6am -6pm. The kitchen and bathroom were toured and inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects, all items were made inaccessible to children. All unused electrical outlets are plugged and play equipment and toys are available. There are age appropriate toys. Licensee is aware that baby walkers, bouncer, or any similar equipment are prohibited in any licensed facility. The backyard is completely fenced. No pets. **There is an in ground pool in the back yard (drained during this inspection). LPA verified the gate entrance into the swimming pool has a spring closure that closes automatically when opened, the fencing is place is wrought iron and stands approximately 6 feet in height.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MELLADO FAMILY CHILD CARE	FACILITY NUMBER: 364806069
	VISIT DATE: 09/22/2021

NARRATIVE

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Licensee has current CPR and First Aid training (exp 3/1/23). Per licensee, there are no weapons or firearms of any kind on the premises. The required fire extinguisher (2A 10BC), smoke detector, and carbon monoxide devises were are present and in in operable condition. Licensee has maintained a current roster and has documented Emergency Disaster drills performed at a minimum of twice a year.

Licensee can access forms on line at www.ccld.ca.gov . LPA observed all required forms posted; Regulation prohibits the smoking of tobacco in any licensed facility.

The licensee is reminded of the requirement to report and unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC 624B.

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.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MELLADO FAMILY CHILD CARE	FACILITY NUMBER: 364806069
	VISIT DATE: 09/22/2021

NARRATIVE

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Issued applicant the following: 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-Rick-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 - LPA explained the new policy for Infants and gave form LIC 9227

******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 o 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 does not provide IMS at this time.

There were no violations noted as a result of this inspection. Exit Interview conducted, a copy of this report was given to Licensee during this inspection.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

LIC809 (FAS) - (06/04)

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