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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009730
Report Date: 03/28/2023
Date Signed: 03/29/2023 07:41:15 AM

Document Has Been Signed on 03/29/2023 07:41 AM - 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MENDEZ FAMILY CHILD CAREFACILITY NUMBER:
198009730
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
03/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee Pilar Mendez TIME COMPLETED:
03:20 PM
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On 3/28/2023 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection at the above facility. LPA met with Licensee Pilar Mendez and informed her of the purpose for the visit. LPA provided Licensee with a copy of the Facility Entrance Checklist. During this inspection, there were six children present . The facility is in compliance for a small family child care home. All residents were noted and verified. All criminal record clearances for adults present were verified.
Facility provides care to children ages 3 months to 12 years old old and the facility operates Monday through Friday 6:30 AM to 6:30 PM.This is a 3 bedroom, 2 bathroom home with a living room, dining area, kitchen, detached garage and enclosed backyard. Per Licensee areas on limits to children are: 2 bedrooms for napping, one bathroom, living room, detached garage used for activities and a section of the enclosed backyard. Per Licensee areas off limits to children are: the kitchen, one section of the backyard, one bedroom and one bathroom inside the master bedroom.
All areas that are accessible to children were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA observed required posted documentation- Facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form, LIC 9040 Facility Roster and a disaster drill log. Licensee had a current copy of the facility roster and the last documented disaster drill was conducted on 3/1/23. There is a carbon monoxide and a smoke detector in the facility. LPA did not test the detectors due to the children napping during the time of the inspection. Licensee will send LPA a video to demonstrate the operational status of the detectors by end of day on 3/28/23. LPA observed a 2A10BC Fire Extinguisher in the facility which indicated full and was serviced on 12/2022. The home has central air and heating. The home maintains telephone service (cell phone). Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. There are toys and other age appropriate materials available for children to use in the garage (day care room). Sharp objects, detergents and cleaning compounds in the kitchen were inaccessible to children in care. Knives are kept in the off limits kitchen and cleaning compounds are kept in an upper cabinet in the laundry area.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2023
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MENDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198009730
VISIT DATE: 03/28/2023
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Per Licensee, none of the children enrolled require medication at the facility. Personal medication is kept in the off limits bathroom.
Children use the bathroom inside the home in the hallway. LPA did not observe hazardous items such as cleaning supplies in the bathroom. Per Licensee, the living room is used as the isolation area in case a child becomes ill and is waiting to be picked up. Children use a section of the backyard for outdoor play. Per Licensee, children are supervised while playing outside.
Per Licensee, there is ant poison in the home and it is maintained in a locked shed. Licensee was advised that all poisons must be locked, not only inaccessible to children. Per Licensee, there are no firearms or weapons stored in the home. There are no pools or spas, or other bodies of water. There is a pet dog in the home.
Infant Care: Currently licensee cares for three infants. LPA observed two cribs in the facility. There is one play yard in the home. a napping cot is also available. LPA observed that napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets. LPA advised Licensee that there shall not be any loose object, bumpers, objects hanging, or objects attached to the cribs. Each infant has their own play yard and bedding. LPA observed sleeping logs for infants enrolled.
Overnight Care: There is no overnight care provided. LPA discussed the following in case overnight care is provided: Licensee is aware that they must remain wake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
Children’s records were reviewed and included (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months).
Licensee has a Pediatric First Aid/CPR certification issued by the American Red Cross on 11/4/22 . Licensee completed mandated reporter for child care providers training in 5/2021. Licensee is reminded that both pediatric first aid/ cpr and mandated reporter shall be renewed every 2 years. Licensee has proof of required immunization to measles. Licensee has a flu declination on file and has TB clearance on file.
During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MENDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198009730
VISIT DATE: 03/28/2023
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Incidental Medical Services (IMS):
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 publication: Commonly Asked Questions about Child Care Center and the ADA, available at: http://www.ada.gov/childqanda.htm
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 Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleephttps://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.
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.
No deficiencies are being cited today.

Exit interview conducted and report was reviewed with the Licensee, Pilar Mendez . Copy of report was provided to Licensee. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
LIC809 (FAS) - (06/04)
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