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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426207903
Report Date: 03/08/2022
Date Signed: 03/08/2022 01:12:12 PM


Document Has Been Signed on 03/08/2022 01:12 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:MEJIA FAMILY CHILD CAREFACILITY NUMBER:
426207903
ADMINISTRATOR:GLORIA TORRES DE MEJIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 925-2876
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 6DATE:
03/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Gloria Torres De MejiaTIME COMPLETED:
01:25 PM
NARRATIVE
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

On 3/8/2022, at 9:15 AM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Required Annual Inspection of the Mejia Family Child Care Home. LPA met with Licensee Gloria Torres De Mejia. The purpose of the visit was discussed with the Licensee and together we toured the inside and outside of the home. LPA observed 5 children and 1 infant in care at the time of the inspection.

The main day care areas are living room, dining room, kitchen, one (1) bedroom and bathroom. LPA observed in the children's bathroom to be free of toxins to children in care. LPA observed the day care area to be clean and orderly. LPA observed age appropriate books, toy, games, tables and chairs. LPA observed the off-limits areas which include the second story 5 bedrooms two (2) bathrooms and garage secured with safe gates and doorknob covers and locks on the doors. The backyard is completely fenced. No bodies of water were observed.

Licensee stated that there are no weapons/ammunition in the home. Licensee stated she does not hold a foster family license. LPA reviewed the facility roster. The fire extinguisher was observed and was serviced January 13, 2022. THIS REPORT CONTINUES ON LIC 809C & LIC 809D
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022
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 6


Document Has Been Signed on 03/08/2022 01:12 PM - It Cannot Be Edited

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: MEJIA FAMILY CHILD CARE
FACILITY NUMBER: 426207903

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation, interview with licensee, and record review, the licensee did not comply with the section cited above On 3/8/22, LPA observed an infant asleep in playpen during the inspection. Licensee stated the infant is 11 months old infant. Licensee stated that she is unaware of new safe sleep regulations. During file review, it was observed that there is no LIC 9227 Individual Infant Sleep Plan or a 15 minute log documenting infant's sleep, which poses/posed a potential health, safety or personal rights risk to persons in care.

LPA provided Licensee's with Safe Sleep Regulations , LIC 9227- Individual Infant Sleep Plan and sleep chart.
POC Due Date: 03/18/2022
Plan of Correction
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Licensee agrees to submit a written statement on how to prevent future occurrences. Licensee agrees to complete LIC 9227 and start sleep log for all infants enrolled in the facility. Licensee also agrees to attending a training offered by the local Resources and Referral office.

Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation, interview with licensee, and record review, the licensee did not comply with the section cited above On 3/8/22, LPA observed an infant asleep in playpen during the inspection. Licensee stated the infant is 11 months old infant. During file review, it was observed that there is no LIC 9227 Individual Infant Sleep Plan or a 15 minute log documenting infant's sleep, which poses/posed a potential health, safety or personal rights risk to persons in care.

LPA provided Licensee's with Safe Sleep Regulations , LIC 9227- Individual Infant Sleep Plan and sleep chart.


POC Due Date: 03/18/2022
Plan of Correction
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Licensee agrees to submit a written statement on how to prevent future occurrences. Licensee agrees to complete LIC 9227 and start sleep log for all infants enrolled in the facility. Licensee also agrees to attending a training offered by the local Resources and Referral office.

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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6


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: MEJIA FAMILY CHILD CARE
FACILITY NUMBER: 426207903
VISIT DATE: 03/08/2022
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There is a functioning carbon monoxide detector and smoke alarm that were tested at 11:01 am, in the home, that meets statutory requirements. Licensee is current with immunization required per SB 792. The last Safety drill was conducted on January 13, 2022 and was available at the time of the inspection. Licensee is current with CPR and First Aid which expires April 21, 2022.

Licensee is not providing Incidental Medical Services. 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: htttp://www.ada.gov/childqanda.htm

Licensee was completed the Mandated Reporter Training required per AB 1207, on August 29, 2020. LPA reviewed with Licensee the Safe Sleep Regulation.(PIN 20-24-CCP) LPA provided a Handout for Reporting Child Abuse and Neglect Training provided on line at www.ccld.ca.gov. and handout on What is Carbon Monoxide, Public Health Guidance, and the Affects of Lead. Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs), Title 22 & Health & Safety Codes which can be accessed on-line athttps://www.cdss.ca.gov/inforesources/child-care-licensing

Today’s visit was conducted in Spanish by LPA Jimenez.

Today, deficiency cited under Title 22 Division 12, Spanish Appeal rights were given. THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS. LPA observed the "Notice of Site Visit" posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6