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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504126
Report Date: 05/24/2024
Date Signed: 05/24/2024 03:00:50 PM


Document Has Been Signed on 05/24/2024 03:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:MENDOZA, ELSA & MENDOZA, JORGEFACILITY NUMBER:
380504126
ADMINISTRATOR:MENDOZA, ELSA & JORGEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 282-3793
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:12CENSUS: 0DATE:
05/24/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Jorge Mendoza, Elsa MendozaTIME COMPLETED:
03:10 PM
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On 5/24/2024 at 1:10PM., Licensing Program Analyst (LPA), Luis Gomez met with Licensee, Jorge Mendoza and Elsa Mendoza. The purpose of today’s visit was explained and was for an unannounced, annual random inspection. Present were both licensees. Per licensee, childcare is currently closed. All adults have criminal record clearances on file. The days and hours of operations are Monday – Friday 8:00AM- 5:00PM. Licensee’s home is a 2 bedroom, 1 bathroom, 1 level unit. The areas of the home designated for childcare are: Living Room (Playroom), Bedroom #1 (Napping only), and Bathroom #1. The areas of the home designated as off-limits are Bedroom #2 (Office). LPA inspected home with licensee for health and safety hazards.

At 1:15PM., the following was observed: Facility was clean, neat, with age-appropriate playthings available for the children. The floors and ground surfaces were clear of obstructions. Accessible furniture, books, puzzles, and supplies were in like-new condition. Facility has cubbies for children’s belongings.

For napping services, LPA observed infant cribs and mats stored in the facility. Bathroom was observed clean with supplies for hand washing. Licensee’s home was a comfortable temperature with ventilation and lighting. The off-limit areas of the home had been made inaccessible. Home had telephone service; functioning carbon monoxide; smoke detector; and fire extinguisher: 2A:10BC located in kitchen. (REFER TO 809C, FOR CONT)

SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MENDOZA, ELSA & MENDOZA, JORGE
FACILITY NUMBER: 380504126
VISIT DATE: 05/24/2024
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Facility/ building does not have any pools, fishpond, jacuzzi, or bodies of water. Per licensee, for outside play children are taken to the local park (Sol).

At 1:50PM., LPA reviewed the facility records.
Licensee’s Cardiopulmonary Resuscitation/ First Aid Certification (CPR) was current, expiring: 6/2024.
Licensee’s ‘Mandated Reporter Training’ (AB1207) was current, expiring: 9/2025.

Licensee is conducting disaster drills with last drill done on 2/15/2024. LPA reminded licensee to log all disaster drill conducted in facility.

The required forms in facility and include the: Child Care License, Notification of Parent’s Rights (PUB379), and Emergency Disaster Plan (LIC610A).

Per licensee, isolation of an ill child is in the playroom. Per licensee, the program provides snack and lunch for children in care.

During inspection, LPA and licensee discussed annual fees due to the department. LPA provided online account access information and current statement.

Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain criminal 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.



LPA discussed the safe sleep regulations with licensee and the Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. (REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MENDOZA, ELSA & MENDOZA, JORGE
FACILITY NUMBER: 380504126
VISIT DATE: 05/24/2024
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Licensee was informed of the www.mychildcareplan.org site is a consumer education website that helps families obtain child care by connecting to child care providers and resources and referral agencies (R&R) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey may 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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety, Code of Regulations. Exit interview and report was reviewed with Licensee, Jorge Mendoza and Elsa Mendoza. Licensee’s signature of this form acknowledges the receipt of these documents.

During exit interview, licensee’s confirmed no registered sex offenders are living in the facility and LPA completed RSO profile. Notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC809 (FAS) - (06/04)
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