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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212416
Report Date: 06/04/2020
Date Signed: 06/04/2020 03:49:36 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:MAGANA-MENDEZ FCCFACILITY NUMBER:
566212416
ADMINISTRATOR:ALICIA MENDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 814-7167
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:14CENSUS: 7DATE:
06/04/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Alicia MendezTIME COMPLETED:
04:00 PM
NARRATIVE
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On June 6, 2020 at 3:00 pm, Licensing Program Analyst (LPA) Betzayra Cervantes made an unannounced phone call to conduct a Case Management inspection. LPA called Licensee Alicia Mendez and advised her the purpose of the inspection. LPA advised Licensee that due to COVID-19 and Department of Public Health (DPH) guidelines of social distancing, a tele-inspection will occur. LPA confirmed with licensee that she had video capabilities with her phone and switched to Facetime to conduct the inspection. LPA observed 7 children during the inspection.

Licensee self-reported an Unusual Incident on 05/18/2020, where Child #1 sustained a superficial partial-thickness burn (second degree) to the upper torso while in care. Interviews with the Licensee and assistant revealed Child # 1 grabbed a teacup, filled with hot liquid from the kitchen table. There were 2 children in care at the time of the incident.

Interview with the assistant revealed that she brought a hot cup of tea from home into the facility at around 9 AM and had placed it on the dining table. The assistant was feeding C1 a banana while holding C1 in her lap. C1 then dropped the piece of banana onto the floor. Then the assistant put the child down while she bent over to pick up the banana, and in that moment C1 was able to access the teacup, outside of the supervision of the Assistant, reaching over the table and knocking the teacup over, spilling hot liquid onto C1’s upper torso.

The licensee rendered First Aid and called C1’s parent. The Licensee stated she did not call EMS because the child was “inconsolable” and could not recall how long it took her to notify C1’s parent. LPA verified licensee’s CPR/First Aid training which expires on 3/2022 and the assistant’s CPR/First aid which expires in 10/2020.

CONTINUED ON LIC 809-C

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra CervantesTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2020
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 3
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: MAGANA-MENDEZ FCC
FACILITY NUMBER: 566212416
VISIT DATE: 06/04/2020
NARRATIVE
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Based on LPAs observations, interviews conducted, and record review, licensee and assistant failed to ensure a safe and healthful environment for C1.

The following California Code of Regulations, 102423(a)(2) and 102417(g)(4) are being cited on the attached LIC 9099D.

An exit interview was conducted with Licensee Alicia Mendez. A copy of the Appeal Rights (LIC 9058) were given and explained. LPA explained the facility's required plan of correction. Licensee was provided the Acknowledgement of Receipt (LIC 9224). Parents shall receive a copy of LIC 9099, LIC 9099C, and LIC 9099D. Each parent/guardian shall sign an LIC 9224 with copies maintained in each child's file. Every parent enrolling a new child in the childcare program shall receive a copy of the report and sign a LIC 9224 for the next twelve months. A copy of this report was reviewed and provided to the Licensee via email. The delivered/read receipt confirmation from email will be in lieu of the signature once she received the report.

THIS VISIT WAS TRANSLATED TO THE LICENSEE IN SPANISH BY LPA CERVANTES.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra CervantesTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: MAGANA-MENDEZ FCC
FACILITY NUMBER: 566212416
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/19/2020
Section Cited

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102423 Personal Rights
(a) Each child receiving services from a family childcare home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:
(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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This requirement was not met, as evidenced by Child #1 having sustained a second degree burn to the upper torso while in care.
This poses and immediate risk to the health and safety of children in care.
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Type A
06/19/2020
Section Cited

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102417 Operation of a Family Child Care Home.
(g) The home shall be free from defects or conditions ... include but not be limited to:
(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
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This requirement was not met, as evidenced by Child #1 had access to a cup of hot liquid on a table in the FCCH, which he ultimately grabbed and spilled onto himself.
This poses and immediate risk to the health and safety of children in care
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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: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra CervantesTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:
DATE: 06/04/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/04/2020
LIC809 (FAS) - (06/04)
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