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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416362
Report Date: 06/13/2024
Date Signed: 06/13/2024 03:12:32 PM

Document Has Been Signed on 06/13/2024 03:12 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
197416362
ADMINISTRATOR/
DIRECTOR:		MENDOZA, ELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 387-6751
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
06/13/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:MENDOZA, ELENATIME VISIT/
INSPECTION COMPLETED:
03:25 PM
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On 6/13/2024 at 12:15 PM, Licensing Program Analyst (LPAs), (Tyra Chavies and Loyce Phillips), conducted an unannounced annual inspection to the facility to ensure the health and safety standards as required governing California family child care homes.
Present at the time of inspection is Mendoza, Elena as well as her assistant, Lopez, Euremia and 5 children in care. Licensee stated that her and her mother are living in the home currently.
PHYSICAL PLANT: LPA toured the facility the inside and outside. The home has 3 bedrooms, 2 and half bathrooms, a kitchen, a living room, a dining room, a side yard, backyard and a attached garage. Bedroom 3, half bathroom, attached garage and backyard will be in use for child care purposes. Licensee has been reminded that the garage can not be used for eating or sleeping. This home will be accessible to children in care, except the following areas: Bedrooms 1 and 2, Bathroom 1 and 2, kitchen, living room, dining room and front door. The isolation room will be either bedroom 3 or the attached garage.
The facility appears to be safe, sanitary and in good repair. All the cleaning products were stored and made inaccessible to the children. LPA reviewed storage of equipment and supplies. Furniture is in good condition, free of any hazards. The bathroom was toured, the toilets flush properly and all faucets are in working order. The food preparation area and storage areas are clean and in sanitary condition. Drinking water is available both indoors and outdoors. The facility has a smoke and carbon monoxide detector. LPA inspected and verified that there is a 3A40BC fire extinguisher. There are no bodies of water on the property.
Play equipment is in good condition and outdoor activity space is maintained in a safe condition and free of any hazards. There are age-appropriate toys, books and equipment for the children, at the time of inspection.
POSTING REQUIREMENTS: License and other relevant notices are visible for public views and correctly posted on the wall. Fire and disaster drills are being conducted as scheduled every six months. Incidental Medical Services were discussed but licensee is currently not providing medicine at this time.
PG1OF3
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Tyra Chavies
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 197416362
VISIT DATE: 06/13/2024
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CHILDREN'S RECORDS: All files are up to date and are good condition.

STAFF'S RECORDS: All files are up to date and are in good condition except for the Licensee Mandated Reporter Training. (Required to be renewed every two years.)

The following were also discussed with the licensing:
  • Assembly Bill 633:  LPA ,Tyra Chavies informed licensee that upon receipt of a Type A deficiency, the licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
  • New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.
  • To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.
  • 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.
  • 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.
PG2OF3
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Tyra Chavies
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 197416362
VISIT DATE: 06/13/2024
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When regulations are approved/changed/updated, providers will be notified through Provider Information Notice (PIN).

An exit interview was conducted with licensee, Mendoza, Elena.
Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following Technical Advisories were discussed. (See LIC 809)  Licensee was provided a copy of their appeal rights.
A copy of this report was read and given to licensee as well as LIC 9213 (Notice of Site Visit form.) LIC 9213 is required to be posted for 30 days.

PG3OF3
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Tyra Chavies
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC809 (FAS) - (06/04)
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