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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376621640
Report Date: 07/06/2021
Date Signed: 07/06/2021 10:51:50 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/07/2021 and conducted by Evaluator Michelle Hood
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20210607110007
FACILITY NAME:MENDOZA, MELANIE FAMILY CHILD CAREFACILITY NUMBER:
376621640
ADMINISTRATOR:MELANIE MENDOZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 755-4195
CITY:IMPERIAL BEACHSTATE: CAZIP CODE:
91932
CAPACITY:14CENSUS: 0DATE:
07/06/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Melanie Mendoza, LicenseeTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Uncleared adult living in the home
INVESTIGATION FINDINGS:
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On 07/06/2021 at 10:30 a.m., Licensing Program Analyst (LPA) Michelle Hood conducted an unannounced complaint inspection for the purpose of delivering the complaint finding, with licensee Melanie Mendoza. Licensee led LPA on a tour of the facility. There were no daycare children in care at the time of inspection.

On 06/11/2021, during the investigation, the licensee admitted to LPA Hood two (2) uncleared adults (Adult #1 & #2) were living in the facility off and on since 03/2020. On 06/14/2021, uncleared adults were fingerprinted and associated with the facility. Licensee understands a civil penalty will be assessed for $1000.00.

AB633 requires upon receipt, the Licensee shall post (observed by LPA) and provide copies of this licensing report to parents/guardians of children in care at the facility and parents/guardians of children newly enrolled at the facility during the next 12 months. An Acknowledgment of Receipt of Licensing Reports, Form LIC 9224 must be signed and placed in each child’s file.

A copy of this report, LIC 9099D, appeal rights (LIC 9058), LIC 9224, and LIC 9213 – Notice of Site Visit were provided to the licensee. LPA observed licensee posed the LIC 9213 and the licensee was advised to post the LIC 9213 for 30 days. An exit interview was conducted with the licensee.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 20-CC-20210607110007
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MENDOZA, MELANIE FAMILY CHILD CARE
FACILITY NUMBER: 376621640
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/21/2021
Section Cited
CCR
102370(d)(1)
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102370(d)(1) Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, ...a California clearance, or a criminal record exemption as required by the Department. This requirement was not met as evidenced by:
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On 06/11/2021, adult #1 & #2 were fingerprinted. As of 06/14/2021, both adults were associated to facility.
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Based on the licensee’s admission, the licensee did not ensure that Adults #1 & #2 had a criminal record clearance or exemption prior to working, residing, or volunteering in the licensed facility as required, which poses an immediate Health and Safety risk to the children in care.
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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: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3