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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434405374
Report Date: 12/19/2019
Date Signed: 12/19/2019 04:08:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MEJIA, YOLANDAFACILITY NUMBER:
434405374
ADMINISTRATOR:MEJIA, YOLANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 288-7210
CITY:SAN JOSESTATE: CAZIP CODE:
95110
CAPACITY:14CENSUS: 9DATE:
12/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Yolanda MejiaTIME COMPLETED:
04:20 PM
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LPA Janet Tse met with licensee Yolanda Mejia for an annual/random inspection. LPA explained the nature of today's visit to Licensee. At arrival, LPA observed four children including one infant in the home with Licensee and her husband. Licensee's daughter Marisela Mejia arrived at the home later, and licensee's husband left to pick up five school age children. There were nine children including one infant and five school age children in total during today's inspection. Adults living in the home are Licensee and her husband. Days and hours of operation are Monday to Sunday, 5:00am to 9:00pm. An updated LIC 279 Application for a Family Child Care Home License reflecting the current hours of operation and the new phone number was provided to LPA during the inspection.

LPA toured the indoor and outdoor of the home. LPA observed a blocked/covered fireplace and no wall heaters. Off limits indoor: two bedrooms and one bathroom. One of the three bedrooms is used for infant napping only. There are no bodies of water. Licensee stated there is no firearms/weapons in the home. Sharp objects, medicines, poisons and cleaning supplies are inaccessible to the children. Outdoor area is fenced. Off limits outdoor: fenced off area and the detached garage. LPA observed a dog in the off limits backyard area. Licensee states the dog is vaccinated. LPA reminded Licensee that she can only have 14 children according to her license.

Fire extinguisher is size 3A40BC and filled. Smoke detector and carbon monoxide detector are operable. Home is clean and orderly with heating and ventilation for safety and comfort. LPA observed sufficient materials, toys, and play equipment for the day care children. Telephone is in working order. Children were supervised on the visit and LPA went over substitute options. LPA also discussed if Licensee transports children, they are never to be left in parked vehicles, and car seat laws are to be followed.

A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 12/16/2019 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background checks have received criminal clearances and child abuse index clearances or exemptions.
Facility Evaluation Report dated 12/19/2019 to be continued on next page: -Page 1 of 2-
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MEJIA, YOLANDA
FACILITY NUMBER: 434405374
VISIT DATE: 12/19/2019
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Facility Evaluation Report dated 12/19/2019 to be continued from previous page:

LPA observed fire drill log which is to be done every 6 months indicates the last drill was completed on 10/15/2019. LPA obtained a copy of the current roster of the children. LPA observed that Licensee and her husband have current Pediatric CPR/1st Aid expiring 05/05/2020.

Licensee was given a list of the current forms for childcare. Website to download forms and to review regulations: http://www.ccld.ca.gov. LPA discussed the immediate civil penalties for Zero Tolerance of $500, and an ongoing $100 per day per violation continues until the violation(s) is corrected. LPA also discussed the Healthy Beverage Act and AB633 requirements for type A violation. AB792 Immunization Requirements was discussed. LPA observed the required immunization records for Licensee, her husband and her daughter who are also her assistants were in file. Licensee and her husband opts out of the influenza vaccine.

Effect of Lead Exposure handout dated 1/20/19 given during today’s inspection. Licensee understands that per Assembly Bill (AB 2370), written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians. LPA reviewed infants safe sleep policies with Licensee and provided "A Child Care Provider's Guide to Safe Sleep.” More information can be found at https://cdss.ca.gov/inforesources/Child-Care-Licensing. Incidental Medical Services were discussed with the licensee. The licensee is not providing IMS (Incidental Medical Services) at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care. The Mandated Reporter AB1207 Compliant Child Care Training was also discussed. Website to complete training: https://mandatedreporterca.com. Licensee's and her husband's primary language is Spanish and are currently exempt from the training. Licensee's daughter is in the process of completing the training. Website for provider resources: https://cdss.ca.gov/inforesources/Child-Care-Licensing. Periodic information releases accessible by signing up at: www.myccl.ca.gov.

LPA discussed the requirements of AB633 to licensee and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and licensee understands the requirements.

No deficiency was cited. Notice of site visit was issued and must be posted for 30 days.
-Page 1 of 2-
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2