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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412854
Report Date: 02/09/2024
Date Signed: 02/09/2024 12:03:14 PM

Document Has Been Signed on 02/09/2024 12:03 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MONDRAGON FAMILY CHILD CAREFACILITY NUMBER:
197412854
ADMINISTRATOR:MONDRAGON, REYNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 205-7204
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
02/09/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:43 AM
MET WITH:Reyna Mondragon, Licensee TIME COMPLETED:
12:50 PM
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On 02/09/2024, Licensing Program Analyst (LPA) Justeene Tamayo met with Licensee Reyna Mondragon, who guided analyst on a tour of the facility for the One Year Required inspection. This is a two story, 3 bedroom, 3 bathroom home with kitchen/dining,living room, child care room, laundry room and garage. There is no pool/spa or body of water on the premises. Upon arrival LPA observed 4 preschool children in care. Licensee currently does not have any infants in care but does understand the requirements. Family members residing in the home include 2 adults (licensee and licensee's spouse) and 0 minor children. Facility operation are Monday-Friday 7AM-5PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the childcare rooms located at the rear of the home. There is one large room (#1) and one smaller room for infants (#2).Children use the bathroom located in the large child care room. Children only have access to the child care room (barricaded by safety gate). Off limit areas include all bedrooms, bathrooms #2 and #3, laundry room , and garage. LPA observed the main care area to be fully barricaded by a safety gate. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under kitchen sink with safety latch), medicines (off-limits master bedroom) and hazardous items (sharp knives in kitchen drawer) that can pose a danger to children. LPA observed two clear doors leading to the kitchen area that remains closed at all times. LPA observed a fireplace in the the living room to be screened. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector, Fire Extinguisher (3A40BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible. LPA reminded licensee, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment are allowed. There is a designated area for ill children as necessary in child care room. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2024
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONDRAGON FAMILY CHILD CARE
FACILITY NUMBER: 197412854
VISIT DATE: 02/09/2024
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Fire/Disaster Drill is complete and maintained current. Last Fire/Disaster Drill was completed on 01/20/2024

Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPA did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are under the kitchen sink and in the garage (key lock). Per licensee she cooks for the children. Breakfast, lunch, snacks and dinner are provided. Naps are provided on cots in the main care area.

Outdoor: The backyard is safe for children. The backyard is completely fenced (with block cement). There is no body of water. LPA observed two outdoor play equipment that are safe for children. LPA observed age appropriate toys. Per licensee, there are no pets on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expired on 08/17/2023. Licensee will retake her CPR/First Aid and send proof of completion to LPA Tamayo no later than 02/23/2024. Facility has been cited a Type B Citation. Please see LIC809-D for deficiency page.

Mandated Reporter expired on 02/05/2024. Licensee will retake her mandated reporter training a www.mandatedreporterca.com and send proof of completion to LPA Tamayo no later than 02/23/2024. There are no window cords accessible to children.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONDRAGON FAMILY CHILD CARE
FACILITY NUMBER: 197412854
VISIT DATE: 02/09/2024
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Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), and Safe Sleep Log. Licensee stated currently does not have child care insurance.

Licensee Mondragon 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 licensee Mondragon and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

A notice of site visit was given to licensee and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Reyna Mondragon, along with her appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/09/2024 12:03 PM - It Cannot Be Edited


Created By: Justeene Tamayo On 02/09/2024 at 11:37 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MONDRAGON FAMILY CHILD CARE
FACILITY NUMBER: 197412854

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Licensee's CPR expired in August of 2023, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/23/2024
Plan of Correction
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Licensee shall retake her CPR/First Aid (EMSA approved) in person and send proof of completion to LPA Tamayo no later than 02/23/2024.
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:Mariela Ramon
LICENSING EVALUATOR NAME:Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2024


LIC809 (FAS) - (06/04)
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