406211177-8-31-2021-17-CC-MKST-C6EQ2G-20210831114706

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406211177
Report Date: 08/31/2021
Date Signed: 08/31/2021 11:48:37 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	MENDOZA FCC AKA LITTLE STARS CHILDREN DAYCARE		FACILITY NUMBER:	406211177
ADMINISTRATOR:	YADIRA MENDOZA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 674-9691
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	14	CENSUS: 6	DATE:	08/31/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:26 AM
MET WITH:	Yadira Mendoza		TIME COMPLETED:	11:50 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 8/31/2021 at 10:26am, Licensing Program Analyst (LPA) Melissa Stewart conducted a Facility Risk Assessment for COVID19 via phone with Licensee, Yadira Mendoza. All answers indicated no exposure to COVID19. The purpose of the visit, Required 1 year inspection, was explained. Licensee wore a face covering and documented LPAs temperature upon arrival. LPA observed the required documents, including COVID19 guidance, posted inside of the home on the wall adjacent to the front door. The Family Child Care Home (FCCH) independently contracts with Head Start through Community Action Partnership of San Luis Obispo (CAPSLO). There are three (3) bedrooms and two (2) bathrooms upstairs which are off limits to children. LPA observed that the safety gate at the foot of the stairs was locked. Child care services are provided downstairs in the living room and one bedroom. Licensee stated that children over the age of 2 years are taught and reminded to wear face coverings while indoors. LPA observed age appropriate toys, books and child sized tables and chairs in both the living room and the downstairs bedroom which leads to the outdoor activity area located in the backyard. At time of inspection, there were six (6) children (including one infant) engaged in outdoor activities supervised by an adult Assistant (S1). In the activity area there is shade, a variety of toys, sandbox, tunnel, small climber and play house located on artificial grass. The outdoor activity area for child care is fully enclosed and is separated by a five (5) foot fence from the other side of the backyard which contains an in ground pool . There is a safety gate at both entrances to the kitchen, making it inaccessible to children. Detergents, cleaning compounds, medications and other items such as kitchen knives which could pose a danger to children are stored inaccessible to children. The bathroom used by children was observed to be clean and free of toxins. LPA observed the 2 A10 BC fire extinguisher with a service date of 1/15/2021. Licensee was reminded to service or replace the fire extinguisher yearly. Licensee completes and documents emergency drills. The most recent drill was held on 8/27/21. The entrance to the side of the backyard with the pool is through a gate in the front yard which is latched or the sliding glass door in the kitchen area which has a sliding lock at the top of the door. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MENDOZA FCC AKA LITTLE STARS CHILDREN DAYCARE	FACILITY NUMBER: 406211177
	VISIT DATE: 08/31/2021

NARRATIVE

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Licensee stated that the pool side is off limits to day care children. LPA observed that the pool area is fully fenced. At 11:06am, Licensee demonstrated that the gate swings away from the pool, and is self-closing and self-latching. Licensee stated there are no guns or ammunition in the home. Smoke and Carbon monoxide detector was tested at 11:36am and found to be operational.

Licensee has current Pediatric CPR and first aid expiring on 4/11/2022. Licensee has met SB 792 immunization requirement and completed Mandated Reporter Training per AB 1207 on 4/30/2020. Facility roster, staff files and a sample of children's records were reviewed and found complete.

Infant Safe Sleep Regulation section 102425 was discussed. LPA provided PIN 20-24-CCP, Individual Infant Sleep Plan (LIC9227) and a sample Infant Sleep Log for 15 minute checks of all children under the age of two (2) years. Licensee reported that the “Effects of Lead Exposure” brochure is distributed to all families at time of enrollment. LPA advised Licensee that Title 22, Division 12 regulations for Family Child Care Homes and California Department of Public Health COVID-19 guidelines for child care programs can be accessed on-line at www.cdss.ca.gov. Licensee stated that she is subscribed to receive Provider Information Notices (PINs) from Community Care Licensing Division via email.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that there are no children enrolled who require medications at this time. 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: www.ada.gov/childqanda.htm

In the areas evaluated today, no deficiencies were cited.

A copy of this report and appeal rights were discussed and left with Licensee, Yadira Mendoza, whose signature on this form confirm receipt of these documents.

LPA provided a Notice of Site Visit (LIC 9213) to be posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

LIC809 (FAS) - (06/04)

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