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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400194
Report Date: 09/17/2021
Date Signed: 09/17/2021 01:06:16 PM

Document Has Been Signed on 09/17/2021 01:06 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MELENDEZ FAMILY CHILD CAREFACILITY NUMBER:
198400194
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
09/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria Melendez, LicenseeTIME COMPLETED:
12:54 PM
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Prior to entrance to the facility, LPA Mayra Rivera conducted a Covid 19 assessment and based on the licensee responses to the facility assessment questions, LPA Rivera determined safe to proceed. On Friday, September 17, 2021 at 9:34 AM, Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with Licensee Maria Melendez who guided LPA Rivera on a tour of the facility.

During the inspection, 2 children were present. LPA Rivera observed 2 children playing outdoors Family members residing in the home has been discussed with licensee and are cleared. Operating hours are Monday to Friday, 6:30 AM to 5:03 PM and care for children ages 0 to 12 years.

This facility is a one-story home that consists of three bedrooms, one bathroom, kitchen, living room, dinning room, front and backyard (fenced and gated). Areas that are accessible to children and identified on the facility sketch were inspected by LPA Rivera; living room, dining room, bathroom, bedroom # 3 (daycare room) and backyard. Areas off limits to children include- Laundry room, kitchen, bedroom # 1 and #2.

At approximately 10:20 AM LPA Rivera entered the facility to inspect for safety, comfort, cleanliness, ventilation and working phone. For ventilation, LPA Rivera observed wall heater between dining room and living room with a fire proof cover and a AC wall unit in bedroom # 3 (daycare room). LPA observed the furniture and children materials to be in good condition and age appropriate. LPA observed a safety gate barrier in place between the kitchen and hallway to prevent children entering the kitchen area.

At approximately 10:25 AM, LPA Rivera entered the restroom and observed the toilet, hand washing sink, running water, paper towels and hand soap. LPA observed the bottom cabinets closed and with a child proof lock in place making it inaccessible to children to open cabinet doors. LPA observed the restroom to be in good condition.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MELENDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400194
VISIT DATE: 09/17/2021
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At approximately 10:29 AM LPA observed cleaning compounds items stored inside the bottom kitchen sink and laundry room. LPA observed child proof locks in place making it inaccessible to children to open the cabinets and drawers . For drinking water, LPA observed water container and water bottles.

LPA Rivera asked if there are any pets, poisons, firearms, weapons or bodies of water. Licensee stated she has fishes and no body of waters, firearms, weapons or poisons. LPA did not observe firearms, weapons, poisons nor bodies of water. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.



At approximately 10:35 AM LPA Rivera observed the required 2A10BC fire extinguisher located in the kitchen and the valve on the green area indicating fully charged and serviced on 8/13/2021. LPA observed the smoke detector and carbon monoxide in the daycare room and pressed on the detector and heard the sound. The smoke and carbon detectors are in good condition. LPA informed licensee the kiddie brand combo detector have been recalled and will need to replace the smoke and carbon monoxide detector's. LPA also observed and emergency kit/first aid kit bag in the kitchen.

At approximately 10:45 AM, LPA Rivera inspected the outdoor area used by children for safety, comfort and cleanliness. LPA observed a sail triangle installed and provides adequate shade. LPA observed play equipment to be in good condition and age appropriate. LPA observed the shed closed and locked with a keypad lock. LPA also observed the two side gates closed and locked with a keypad lock. LPA observed a gate barrier installed between the play area and extended yard to prevent children going to the extended yard side.

LPA observed licensee Pediatric First Aid/ CPR certification with expiration date 10-2022. Licensee has proof of immunization against Pertussis, MMR and Influenza. Licensee has completed the health and safety training and mandated reporter (AB 1207) training on 7/27/20. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com.

At approximately 1051 AM LPA reviewed the children roster, and observed LIC 610A Emergency disaster plan, PUB 394 parents rights, emergency drill with last drill conducted on 9-7-21

At approximately 10:53 AM LPA reviewed licensee, child #1 and child #2 files. LPA observed the files to be up to date.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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: MELENDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400194
VISIT DATE: 09/17/2021
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The following was discussed
Safe Sleep: LPA discussed the safe sleep regulations with licensee [or facility representative] 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 Maria Melendez of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at also explained to licensee that car seat, stroller are only and only for https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA Rivera also reviewed Sudden Infant Death Syndrome (SIDS), Never Shake A Baby, and Lead Exposure information with licensee. LPA transportation, highchair is only and only for feeding and stated items cannot be misused. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.



Medication: 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Criminal Record Statement: Licensee Maria Melendez 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.

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

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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: MELENDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400194
VISIT DATE: 09/17/2021
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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.

Exit interview conducted and report was reviewed with the licensee Maria Melendez.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
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