376628435-8-20-2021-20-CC-DMIR-C62P26-20210819105526

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376628435
Report Date: 08/19/2021
Date Signed: 08/20/2021 03:00:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	MENDOZA, JENNIFER & GRACIELA FAMILY CHILD CARE		FACILITY NUMBER:	376628435
ADMINISTRATOR:	A		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 319-0193
CITY:	IMPERIAL BEACH	STATE: CA	ZIP CODE:	91932
CAPACITY:	14	CENSUS: 3	DATE:	08/19/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Jennifer Mendoza		TIME COMPLETED:	11:00 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 August 19^th, 2021 at 09:01 a.m., Licensing Program Analyst (LPAs) David Miller and Jo Ann Legaspi conducted an unannounced Annual Required. Inspection and met with the Licensee Jennifer Mendoza LPAs disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Three (3) children and two (2) staff were present in the facility during this inspection. One child was the Licensee's biological child. This facility is a one (1) story, three (3) bedroom, two (2) bathroom house. Licensee accompanied LPAs inside and out of the facility during this inspection. The following areas used for child care are family room, room 1, room two, and the backyard. Off limits areas are the garage and licensee's bedroom which are made inaccessible through use of child proof lock on door. The kitchen is also off limits and made inaccessible via a baby safety gate. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The storage area for poisons is locked. The licensee has toys, play equipment and materials available. The home has a fenced backyard available for outdoor activities. No bodies of water observed on the premises during the inspection Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee’s First Aid and CPR certifications expire on 04/07/2023 Licensees have required immunizations. Licensees completed Mandated Reporter Training on 08/04/2021. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 08/04/2021.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: David Miller	TELEPHONE: (619) 987-8901
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MENDOZA, JENNIFER & GRACIELA FAMILY CHILD CARE	FACILITY NUMBER: 376628435
	VISIT DATE: 08/19/2021

NARRATIVE

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LPAs provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPAs discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

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.

LPAs discussed the licensee's fees due by August 30th, 2021. Licensee stated that she tried to pay online but was not able to get the payment information to work. LPAs provided licensee with the facility PIN, and licensee stated that she will pay the fees owed by the due date.

No deficiencies cited

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: David Miller	TELEPHONE: (619) 987-8901
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MENDOZA, JENNIFER & GRACIELA FAMILY CHILD CARE	FACILITY NUMBER: 376628435
	VISIT DATE: 08/19/2021

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	An exit interview was conducted with the Licensee. The Licensee was provided a copy of their Licensee/Appeal Rights (LIC 9058 1/16) and their signature on this form acknowledges receipts of these rights. LPAs provided the Licensee with the Notice of Site Visit (LIC 9213 01/04). Licensee agreed to post this document for public viewing.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: David Miller	TELEPHONE: (619) 987-8901
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC809 (FAS) - (06/04)

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