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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585405073
Report Date: 07/22/2022
Date Signed: 07/22/2022 01:32:01 PM


Document Has Been Signed on 07/22/2022 01:32 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:MENDOZA, OFELIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
585405073
ADMINISTRATOR:MENDOZA, OFELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 743-6715
CITY:OLIVEHURSTSTATE: CAZIP CODE:
95961
CAPACITY:14CENSUS: 5DATE:
07/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Ofelia MendozaTIME COMPLETED:
01:35 PM
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On 7/22/2022 at 9:50am, a Required -1 Year inspection was made to the facility by Licensing Program Analyst (LPA), Laura Chavez. Upon arrival to the home LPA met with the licensee's husband. At 10:05am the home was toured inside and outside. The licensee's husband and assistant were supervising five children and operating within the licensed capacity and ratio requirements. Licensee Ofelia Mendoza arrived at approximately 10:20am. The facility operates 24 hours a day, seven days a week. The licensee understands that 24 hour care to one child at one time is not allowed. A review of the Facility Personnel Report Summary dated 7/7/2022 found that the licensee's assistant (A1) has not received the required criminal record and child abuse index clearances. The floor plan and yard sketch submitted by the licensee were reviewed. The off-limits areas of the home are the three bedrooms, main bathroom, kitchen, office and living-room and were made inaccessible by a gate and locks. The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard.

Items that could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. Poisons are locked in a storage shed located behind a fence that divides the children's outdoor play area and area where storage shed is located. LPA observed a working smoke detector, carbon monoxide detector, and fire extinguisher, rated at least 2A10BC, in the home. The roster of children in care was reviewed and was current. The licensee conducted an emergency drill within the past six months, the last drill was documented on 7/4/2022.

Report continued: See LIC809-C's
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2022
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 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: MENDOZA, OFELIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 585405073
VISIT DATE: 07/22/2022
NARRATIVE
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Five children's records were reviewed at 11:00am. Three staff records were reviewed at 10:35am.

Currently three adults live in the home. The Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep web page at:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-
resources/safe-sleep as an additional resource. LPA also informed the licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

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SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: MENDOZA, OFELIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 585405073
VISIT DATE: 07/22/2022
NARRATIVE
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The following deficiencies were cited: A Type A deficiency was cited for a Criminal Record Clearance 102370(d) - an interview conducted with the licensee at 10:25am found that the licensee failed to get her 18 year old daughter/assistant livescanned as required. A Type B citation was cited for Immunizations 102418(g) - children file reviews conducted at 11:00am discovered that the licensee failed to obtain immunization records for C3, C4 and C5 (see LIC 809D's):

LPA Laura Chavez informed licensee Ofelia Mendoza that this report dated 7/22/2022 documents one Type A citation. Type A citations shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Laura Chavez informed the licensee to provide a copy of this licensing report dated 7/22/2022 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. An exit interview was conducted, and the report was reviewed with licensee Ofelia Mendoza.



To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at:www.cdss.ca.gov/inforesources/community-care-licensing/process

Notice of Site Visit was given and must remain posted for 30 days. Failure to comply with postingDocument Link Icon requirements shall result in an immediate civil penalty of $100. Page 3 of 3
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5
Document Has Been Signed on 07/22/2022 01:32 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926


FACILITY NAME: MENDOZA, OFELIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 585405073

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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The licensee failed to obtain a criminal record clearance for her 18 year old daughter/assistant. Based on an interview, the licensee did not comply with the section cited above in one out of three staff file reviews which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/23/2022
Plan of Correction
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The licensee agrees to provide proof of having her 18 year old daughter/assistant livescanned to CCLD on or before 7/23/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5


Document Has Been Signed on 07/22/2022 01:32 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926


FACILITY NAME: MENDOZA, OFELIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 585405073

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on children record reviews, the licensee did not comply with the section cited above in three out of five file reviews which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2022
Plan of Correction
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The licensee agrees to provide copies of current immunization records for C3, C4 and C5 to CCLD on or before 8/22/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5