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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543905918
Report Date: 07/11/2019
Date Signed: 07/12/2019 02:20:19 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, LUCIA FAMILY CHILD CAREFACILITY NUMBER:
543905918
ADMINISTRATOR:MENDOZA, LUCIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 783-2386
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:14CENSUS: 3DATE:
07/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lucia Mendoza, LicenseeTIME COMPLETED:
11:00 AM
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(3) LPA Pete Espinoza made an unannounced Annual/Random inspection. LPA met with Lucia Mendoza, Licensee (Spanish Speaking), who provided a tour of the home, inside and outside, as shown on the facility sketch. There are no "bodies of water" or firearms in this facility. Storage areas for poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children; and poisons are locked. There is no fireplace. Fire extinguishers and smoke/carbon monoxide detectors meet State Fire Marshall standards. The home is kept clean and orderly, with heating and ventilation for safety and comfort. There are no stairs in the home. The home provides safe toys, play equipment, and materials. The licensee is present in the home and ensures that children in care are supervised at all times. When temporarily absent from the home, the licensee arranges for a substitute adult to care for and supervise children in her/his absence. The home conducts fire and disaster drills at least once every six months, and documents the date and time of each drill. Licensee documents immunizations and maintains and updates records for children in care. All individuals subject to a criminal record review have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home. The licensee and other personnel have completed training in pediatric CPR and First Aid; Expires: 05/21/2021.
Business hours are Mon-Fri 6:00 AM to 6:00 PM and other hours as arranged.
Licensee provided proof of required immunization (Pertussis/Measles/influenza and/or written declaration declining flu shot) AND Certificate of Completion for required Mandated Reporter Training.
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: http://www.ada.gov/childqanda.htm.
NO DEFICIENCIES OBSERVED IN THE AREAS INSPECTED DURING TODAY’S VISIT.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
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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