543809290-11-13-2019-04-CC-DMEO-BHVTZF-20191113141017

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 543809290
Report Date: 11/13/2019
Date Signed: 11/13/2019 02:10:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	MENDOZA, YOLANDA FAMILY CHILD CARE		FACILITY NUMBER:	543809290
ADMINISTRATOR:	MENDOZA, YOLANDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 804-3506
CITY:	LINDSAY	STATE: CA	ZIP CODE:	93247
CAPACITY:	14	CENSUS: 6	DATE:	11/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Yolanda Mendoza		TIME COMPLETED:	02:25 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 Analyst (LPA) Diane Mercado conducted an unannounced annual inspection. LPA met with Licensee Yolanda Mendoza also present was licensee husband and sister. Licensee is Spanish speaking and interpretive services were provided by LPA Mercado. LPA conducted a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. The rooms accessible to children in care are: living room #1 (near front entrance), kitchen, living room #2, bedroom #1, hallway bathroom, and back yard. Off-limits rooms are made inaccessible via plastic door knob spinners and locks. Two dogs observed during today’s inspection; licensee is aware of the safety of children around animals. Licensee stated her pets are kept inaccessible from children via garage. There are no "bodies of water" or firearms in this home. Swimming pool is fenced per regulation. The pool gate is self-latching, self-closing and opens away from the swimming pool. There are There are no firearms in the home. No poisons were observed on the premises. Cleaning compounds, medications and other hazardous items are inaccessible to children. Fireplace is blocked and inaccessible to children in care. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. There are no stairs in the home. There is a working telephone and number was verified. Adequate supervision is being provided during this inspection. Children are supervised when outside in the fenced play area. Capacity as specified on the license is being maintained. Licensee has a current roster of the children. Licensee maintains documentation of immunizations for the children. Licensee maintains documentation of immunizations for pertussis, measles and influenza for herself. Licensee has provided parents with a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Fire drills are conducted and documented with the date and time every six months. Licensee is aware that children are never to be left in parked vehicles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care. Pediatric CPR/First Aid is current and expires 12/05/2018. Mandated Reporter training AB 1207 was completed 07/04/2018. Days and hours of operation are Monday – Saturday; 5:00 AM – 9:00 PM. Continued 809-C

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane Mercado	TELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MENDOZA, YOLANDA FAMILY CHILD CARE	FACILITY NUMBER: 543809290
	VISIT DATE: 11/13/2019

NARRATIVE

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Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. Postings such as Emergency Disaster Plan, Earthquake preparedness checklist, facility license and notification of parents’ rights poster are posted on front door entrance wall. Licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

This facility does not provide Incidental Medical Services – IMS. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited. Exit interview conducted with licensee Yolanda Mendoza.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Diane Mercado	TELEPHONE: (559) 341-6334
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

LIC809 (FAS) - (06/04)

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