274416823-7-28-2023-07-CC-JCRZ-CU6PEC-20230728111454

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274416823
Report Date: 07/28/2023
Date Signed: 07/28/2023 11:15:00 AM

Document Has Been Signed on 07/28/2023 11:15 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	MENDEZ, AMBER		FACILITY NUMBER:	274416823
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/28/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Amber Mendez		TIME COMPLETED:	11:40 AM

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	Licensing Program Analyst (LPA) Janette Cruz conducted an announced pre-licensing inspection with Amber Mendez, Applicant. The purpose of today's inspection: address the Application for a new Small Family Child Care Home license that the Applicant submitted to the Department on 05/25/2023. Application/Record Review: The Applicant was the only adult present in the home during today's inspection. The Applicant states that she is the only adult residing in the home. Applicant also has minor children (sons ages 16, 7, 2.5 years and daughter age 4 years ) residing in the home. Days and hours of operation will be Monday to Friday, 7:00AM to 6:30PM. Applicant has proof of Pediatric CPR and First Aid training with expiration date of 09/2024 on file. Applicant has updated vaccinations (flu opt-out) and proof of completion of the Mandated Reporter Training for Child Care Workers completed on 05/11/2023 are on file. The Applicant rents the home and a copy of rental agreement verifying control of property is on file. Applicant states that she intends to have up to eight children in her day care. The Applicant agreed to give LPA a tour of the home during today’s inspection. LPA observed the home is a two-story home with three bedrooms, two bathrooms, living room, kitchen, dining area, attached garage, and backyard, LPA observed that the there is a working telephone in the home (cell #831-500-3751). LPA observed the home is clean and orderly, with centralized heating and ventilation for safety & comfort. The off-limit areas inside the home are: entire second floor (2 bedrooms, 1 bathroom, and on the first floor (kitchen, garage). Off-limit areas outside the home - None.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MENDEZ, AMBER	FACILITY NUMBER: 274416823
	VISIT DATE: 07/28/2023

NARRATIVE

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LPA observed no bodies of water. LPA observed a barricaded fireplace and no open face heater units in the home. There are safe and age- appropriate toys, play equipment, and materials for the children. LPA observed the outdoor backyard area of the home is fenced and secure for the children.

LPA observed that the Applicant has designated the dining area where child(ren) can be isolated if exhibiting signs of illness. The home has at least one working smoke and carbon monoxide detector in the home. LPA observed Applicant has one fully charged fire extinguisher (2A10BC) inside the home. Applicant states that there are no firearms or weapons in the home. LPA observed that Applicant has three cats in the home that Applicant stated she is currently fostering and would be kept away from children. All cleaning compounds and medications are adequately stored in locked cabinets and in the locked hallway closet, inaccessible to children. Applicant was reminded that any poison inside the home must be kept locked. Applicant states that they do not have any baby walkers in the home. Applicant understands that baby walkers are not allowed in the day care. Applicant understands that high chairs are to be used only for eating purposes. Applicant states that no adults smoke and understand that smoking is prohibited in the home.

Kitchen tour: LPA observed the refrigerator and freezer in the home are clean. There are no sharp utensils, cleaning products, lighters/matches, or open bottles of alcohol accessible to children. Applicant understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated.

Bathroom tour: LPA observed the bathroom toilet and faucet are clean, safe, and operable. All shampoos, medication, mouthwash, perfumes, lotions/cosmetics, cleaning products/solvents are inaccessible to the children.

Forms of discipline to be used by Applicant: redirection, positive reinforcement and talking to children. The Applicant understands that children's personal rights should not be violated; including no corporal punishment, supervision of children, transportation of

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MENDEZ, AMBER	FACILITY NUMBER: 274416823
	VISIT DATE: 07/28/2023

NARRATIVE

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children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed with the Applicant during today's inspection.

LPA reviewed with the Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

This facility will wait to determine for need to implement Incidental Medical Services (IMS). 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

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 the Applicant 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 Applicants 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.

Exit interview conducted and report was reviewed with the Applicant, Amber Mendez. LPA advised Applicant that a small Family Child Care Home license will be approved upon review and approval by LPA's manager.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

LIC809 (FAS) - (06/04)

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