203804611-2-16-2023-04-CC-DJIZ-CP4SH3-20230216125253

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 203804611
Report Date: 02/16/2023
Date Signed: 02/16/2023 12:53:23 PM

Document Has Been Signed on 02/16/2023 12:53 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	MENDEZ DAY CARE		FACILITY NUMBER:	203804611
ADMINISTRATOR:	MENDEZ, ANA MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 665-2518
CITY:	CHOWCHILLA	STATE: CA	ZIP CODE:	93610
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 5	DATE:	02/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Ana Maria Mendez		TIME COMPLETED:	01:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 02/16/2023 Licensing Program Analysts (LPAs), Denisia Jimenez and Theresa Marquez conducted an unannounced Annual Required Inspection and was met by Licensee, Ana Maria Mendez. Also present was Staff #1 Imelda Mendez-Morales (S1). Licensee is Spanish Speaking. Days and hours of operation are Monday-Friday from 6:00 to 5:30 PM and other hours as arranged. The home has working telephone service and LPA confirmed the phone number is (559) 665-2518. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that the living room, dining room, and hall bathroom are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of safety and spinner knobs. The outdoor play area in the front yard is fenced and there are no hazards to children present. The backyard is off limits. There is one cat. Licensee understands the liability of pets around day care children and accepts responsibilities of any action taken by pets. Swimming pool is fenced per regulation. The pool gate is self-latching, self-closing and opens away from the swimming pool. No windows or doors have direct access to the pool area. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. The fireplace located in the living room is made inaccessible by a locked screen gate and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. LPA discussed the safe sleep regulations with licensee 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. Continued on LIC809-C

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Denisia Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MENDEZ DAY CARE	FACILITY NUMBER: 203804611
	VISIT DATE: 02/16/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Licensee ensures that children in care are always supervised and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Capacity as specified on the license is being maintained. LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 06/17/2021. Licensee’s pediatric CPR/First Aid expires on 09/17/2024. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. 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. Incidental Medical Services (IMS) are not currently being provided. (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) LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations. 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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: Parent Notification Additional Children form LIC 9150 is missing from children’s files as per requested during the 04/25/22 annual inspection. (see next page, 809 D)

Exit interview conducted and report was reviewed with the facility representative Ana Maria Mendez. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Denisia Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 02/16/2023 12:53 PM - It Cannot Be Edited

Created By: Denisia Jimenez On 02/16/2023 at 12:20 PM

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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MENDEZ DAY CARE	FACILITY NUMBER: 203804611
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421.(d)(1)

Child’s Records. (d) In any case in which the licensee cares for an additional child pursuant to Section 102416.5(b) for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child's record, proof of parent notification that the facility is caring for an additional child as required in Section 102416.5(h). (1) The licensee shall maintain a completed and signed LIC 9150 (Rev. 8/14) Parental Notification Additional Children in Care, which is incorporated by reference, for this purpose. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in 2 out of 5 children's records files. Form LIC 9150 is missing from children's file which poses a potential health, safety or personal rights risk to children in care.
	POC Due Date: 02/24/2023
	Plan of Correction
1 2 3 4	Licensee stated she will obtain form LIC 9150 from parent's for children's files by POC due date 02/24/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Juvenal Moctezuma

LICENSING EVALUATOR NAME:

Denisia Jimenez

LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3