406215057-10-15-2019-17-CC-MKST-BGYULL-20191015154055

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215057
Report Date: 10/15/2019
Date Signed: 10/15/2019 03:41:02 PM

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 FAMILY CHILD CARE		FACILITY NUMBER:	406215057
ADMINISTRATOR:	MARIA MENDOZA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 473-2802
CITY:	OCEANO	STATE: CA	ZIP CODE:	93445
CAPACITY:	14	CENSUS: 6	DATE:	10/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Maria Mendoza		TIME COMPLETED:	03:45 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 Analysts (LPAs) Melissa Stewart and Elvin Baddley conducted an unannounced annual/random inspection and met with licensee, Maria Mendoza. The home was toured inside and out. All required forms are posted in a prominent location. There were 6 children napping on cots at the time of inspection. LPA observed age appropriate toys, books and furnishings in the indoor activity area. The bathroom used by children was observed to be clean and free of toxins. Off limits areas are made inaccessible by child proof door knob locks. All hazardous items are stored inaccessible to children in care. Licensee stated there are no guns or ammunition in the home. The backyard is completely fenced. LPA observed artificial grass and age appropriate toys. There are no bodies of water. Fire extinguisher was serviced on 2/20/19. Carbon monoxide and smoke detectors were observed to be operational. Licensee completes and documents emergency drills. The most recent drill was held on 10/7/19. Licensee is current with CPR and first aid which expires on 1/9/21. Licensee has met immunization requirement. Children's records were randomly reviewed and found complete. Children's roster was reviewed. 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: 10/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019

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 FAMILY CHILD CARE	FACILITY NUMBER: 406215057
	VISIT DATE: 10/15/2019

NARRATIVE

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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: www.ada.gov/childqanda.htm

LPA reviewed and provided Licensee with a copy the Safe Sleep brochure in English and in Spanish. LPA provided “Effects of Lead Exposure” to be distributed to all families. Licensee was advised to review Quarterly Updates and Provider Information Notices (PINs) which can be accessed on-line at www.ccld.ca.gov.

In the areas evaluated, no deficiency cited.

LPA observed Licensee post the Notice of Site visit.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019

LIC809 (FAS) - (06/04)

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