334815328-5-2-2025-10-CC-NHUO-DGATJL-20250502144632

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334815328
Report Date: 05/02/2025
Date Signed: 05/02/2025 02:46:40 PM

Document Has Been Signed on 05/02/2025 02:46 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	MENDOZA FAMILY CHILD CARE		FACILITY NUMBER:	334815328
ADMINISTRATOR/ DIRECTOR:	MENDOZA, ADRIANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 342-9488
CITY:	INDIO	STATE: CA	ZIP CODE:	92201
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 4	DATE:	05/02/2025
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:50 PM
MET WITH:	Adriana Mendoza		TIME VISIT/ INSPECTION COMPLETED:	02:55 PM

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On 5/2/2025 at 1:50 PM, Licensing Program Analyst (LPA) Naomi Hurtado conducted a case management visit at the facility. A case management visit is being conducted in response of an unusual incident report (UIR) from the facility dated 4/10/2025. LPA met with Licensee Adriana Mendoza and advised them of the reason for the visit.

During the visit LPA conducted a walk through of the home, reviewed the UIR, facility records, and conducted an interview with Licensee. LPA did not interview C1 and C2 as they were too young to interview. Licensee stated that on the day of the incident C1 and C2 were at the top of the play structure with the orange slide. Licensee stated that she in the process of pulling the other play structures onto the grass. Licensee stated she saw that C1 was preparing to sit down to slide and C2 suddenly pushed C1 off the slide. This caused C1 to fall onto the concrete. Licensee reported the incident to all appropriate parties and the next day, C1 came back to the facility. At this visit, Licensee showed LPA where she was standing which was about 10 feet away from the play structure that C1 and C2 were on. LPA observed that Licensee placed padding on the concrete area of her yard. Licensee places the play structures under the patio cover (on top of the padding) in order to protect the toys from the sun. However, Licensee stated that she continues to move the structures to the grass. Licensee now makes the children wait until she moves the play structures to the grass before they can use it. Based on observation, interviews, and record review, there are no deficiencies.

A notice of site visit was given to Licensee Adriana Mendoza and must remain posted and in view of the public for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. An exit interview was conducted with Licensee Adriana Mendoza. Licensee was provided with a copy of this report and appeal rights were discussed.

NAME OF LICENSING PROGRAM MANAGER: Deborah Mullen
NAME OF LICENSING PROGRAM ANALYST: Naomi Hurtado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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