197412331-11-8-2022-30-CC-DMIA-BC93E9-20190516181045

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197412331
Report Date: 05/16/2019
Date Signed: 11/08/2022 03:56:04 PM

Document Has Been Signed on 11/08/2022 03:56 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	MENDOZA FAMILY CHILD CARE		FACILITY NUMBER:	197412331
ADMINISTRATOR:	MENDOZA, MARIZA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 695-6277
CITY:	WESTCHESTER	STATE: CA	ZIP CODE:	90045
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	05/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Mariza Mendoza, Licensee and two licensee's assistan		TIME COMPLETED:	05:15 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	**This is an amended version of a report a report that was created on 05/192019. The report is being amended to change the findings of the case management results. On 5/16/19, Denise Miranda, Licensing Program Analyst (LPA) conducted an unannounced annual/required visit inspection to ensure the health & safety standards as required by regulations governing family child care homes are being met. Upon arrival, at 3:15pm, LPA met with licensee Mariza Mendoza, Licensee and two assistants and informed licensee of nature of the visit and was guided on a tour (inside and outside) of the home. LPA confirmed with licensee that all adults residing/working in the home have criminal record clearance. LPA confirmed with licensee that all adults residing/working in the home have criminal record clearance.” Upon arrival LPA Miranda observed ten children in care with licensee and two assistants. This is a 1 story, 3 bedrooms, 1.5 bathroom home with kitchen, living room, and detached garage. LPA's observed a separate living space next door. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include licensee and two adult’s family members. Licensee stated the facility is operating Monday-Friday 7:30am-5:30pm The accessible areas for child care include: play room, living room, kitchen with combining dining room and outdoor area. The off-limits** areas include: Master bedroom, one bathroom located at the hallway by the bedroom #1 and #2. Detached garage. Per licensee the detached garage is used only for storage. At 3:35pm LPA observed a full charged Fire extinguisher size 3-A:40-B:C Fire Extinguisher full charged in the kitchen, first aid kit located at the playroom area, working smoke and carbon monoxide detector, age appropriate toys. The home central air. LPA observed licensee current First Aid Infant & Child CPR certifications are valid thru 12/2019. Fire Drill was completed 1/19/2019, Telephone service, heating, lighting and ventilation were evaluated and in good condition.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 197412331
	VISIT DATE: 05/16/2019

NARRATIVE

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A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility. Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. The fire extinguisher type 3A40BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check, and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Fire and safety drills must be performed every six months and documented for review by the Department.

Smoking is prohibited in a family child care home. Children and Staff records must be maintained and updated as needed and must be available for review by the Department. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

Licensee informed fire drill to be completed every 6 month and to keep a log and to ensure records for staff and children as well as a roster are kept for 3 years. Licensee informed no smoking in the premises during daycare hours of operation and was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category.

A copy of report, a Notice of Site Visit and advisory notes were issued and explained to the Licensee.

SUPERVISORS NAME: Jennie Ferreira
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 197412331
	VISIT DATE: 05/16/2019

NARRATIVE

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The licensee states that does not have weapons/firearms in the home and none observed by the LPA. LPA observed a closed and fenced in chicken coup that's inaccessible to children in care. Children use the front of the home for reading and activities. LPA's observed perimeter fencing for safety, age appropriate toys, small climbing structure and activities for children in care. All plants, trees and shrubs are maintained neat and clean.
LPA reviewed the child’s file was completed.
Update on Incidental Medical Services: Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department. Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.

For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417.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

The following was discussed with the licensee:

Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license and immunization. Licensee was informed, Absence of Supervision: including, but not limited to, a child left unattended, a child left alone with a person under 18 years of age, and lack of supervision resulting in a child wandering away. (HSC 1597.58(c)(2)). Regulation(s): 102417(k)(1) Children shall not be left in parked vehicles. Civil penalty applies when a child is left unattended in a parked vehicle.

SUPERVISORS NAME: Jennie Ferreira
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 197412331
	VISIT DATE: 05/16/2019

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Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

Mandated Reporter training: www.mandatedreporterca.com

Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541. Email Address: childcareadvocatesprogram@dss.ca.gov

During this inspection, LPA also provided the following documents about SIDS. 1) A Child Care Provider’s Guide to Safe Sleep by the American Academy of Pediatrics, 2) 1-844-LET-US-NO, 3) Never ever shake a Baby by California Department of Social Services, 4) California School Immunization Record form CDPH286, 5) California Law – Car Seat by California Department of Public Health, LIC311D Forms/Records to Keep in your Family Child Care Home.

The facility was found to be in substantial compliance per Title 22 Regulations.

SUPERVISORS NAME: Jennie Ferreira
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

LIC809 (FAS) - (06/04)

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