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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197419784
Report Date: 08/15/2024
Date Signed: 08/15/2024 01:15:28 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/17/2024 and conducted by Evaluator Mayra Rivera
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20240717142859
FACILITY NAME:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
197419784
ADMINISTRATOR:MENDOZA, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 946-8531
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:14CENSUS: 8DATE:
08/15/2024
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Teresa Mendoza, LicenseeTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Licensee is operating over capacity.
INVESTIGATION FINDINGS:
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On Thursday, August 15, 2024, at 10:50 a.m., Licensing Program Analyst (LPA), Mayra Rivera conducted an unannounced Complaint Investigation. On this day Licensing Program Analyst (LPA) Mayra Rivera delivering findings of the above allegations. Upon arrival, LPA met with licensee Teresa Mendoza who was supervising 8 children (3 infants, 4 preschool and 1 school-age) and assistant present. LPA observed children playing indoors.

During the course of this investigation, LPA reviewed documentation and observed children. Based on the observations and documentation it did not support nor confirm the allegation of licensee operating over capacity. This agency has investigated the complaint. At this time, it is determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and therefore at this time the above allegation is unsubstantiated. No deficiency given at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 12-CC-20240717142859
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 197419784
VISIT DATE: 08/15/2024
NARRATIVE
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 The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with licensee Teresa Mendoza.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/17/2024 and conducted by Evaluator Mayra Rivera
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20240717142859

FACILITY NAME:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
197419784
ADMINISTRATOR:MENDOZA, TERESAFACILITY TYPE:
810
ADDRESS:1817 E. KETTERING STTELEPHONE:
(661) 946-8531
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:14CENSUS: 8DATE:
08/15/2024
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Teresa Mendoza, LicenseeTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Personal Rights
INVESTIGATION FINDINGS:
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On Thursday, August 15, 2024, at 10:50 p.m., Licensing Program Analyst (LPA), Mayra Rivera conducted an unannounced Complaint Investigation. On this day Licensing Program Analyst (LPA) Mayra Rivera delivering findings of the above allegation. Upon arrival, LPA met with licensee Teresa Mendoza who was supervising 8 children (3 infants, 4 preschool and 1 school-age) and assistant present. LPA observed children playing indoors.

During the course of this investigation, LPA Rivera reviewed documentation and conducted confidential interviews. Based on confidential interviews and documentation, there is preponderance of evidence that supports personal rights violation occurred among child #1 and child # 2 and therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22 102423 (a)(1) -are being cited on the attached LIC9099D.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 12-CC-20240717142859
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 197419784
VISIT DATE: 08/15/2024
NARRATIVE
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Upon receipt of this report, the licensee shall post any licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year.

A copy of the Parent Notification Requirements was provided to the licensee, along with a copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports.

Exit interview was conducted with licensee Teresa Mendoza. The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 12-CC-20240717142859
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 197419784
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/16/2024
Section Cited
CCR
102423(a)(1)
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Personal Rights-(a) Each child receiving services from a family child care 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:
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Licensee stated is in the process of hiring another assistant to ensure there is active supervision at all times. Will place assistants in accessible rooms (family room, living room, dining area and outdoor). There will be a total of 3 staff present providing care and supervision.
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(1) To be treated with dignity in his/her personal relationship with staff and other persons. Based on confidential interviews and documentation provided and reviewed, there is preponderance of evidence that supports personal rights violation occurred with child #1 and child # 2 and therefore the above allegation is found to be Substantiated
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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: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5