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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700147
Report Date: 07/06/2021
Date Signed: 07/06/2021 12:08:06 PM

Document Has Been Signed on 07/06/2021 12:08 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
367700147
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
07/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Yamileth MendozaTIME COMPLETED:
12:20 PM
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On the 07/06/2021 at about 10.17 AM Licensing Program Analyst (LPA) Mabika met with licensee Yamileth Mendoza and access was granted. The purpose of the inspection is to conduct an Annual/Random Inspection. Licensee is licensed to provide care and supervision for a Small Family Child Care for the capacity of 8 children. There are currently 10 children enrolled in the family childcare. Present during the time of this inspection is licensee, sister and 3 children in care. Per licensee residing in the home on the above is licensee, sister, sister's spouse, nephew. Per licensee, all adults residing in the home have a Criminal Record Clearance. Licensee and LPA toured the areas of the home utilized for the Family Child Care to ensure the home is in compliance with Community Care Licensing Title 22 Regulations. The days and hours of operation are Monday through Friday 7.00 AM to 5.00 PM.
The home is set-up as follows:
This is a single-story house with 3 bedrooms, 2 bathrooms, kitchen/dining room, living room, and detached garage. Per Licensee the living room, hallway bathroom, 1 bedroom and the backyard is utilized for the family child care activity area. Per licensee off-limit areas of the home is 3 bedrooms,en-suite bathroom and the front yard.
The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, poisons, detergents/cleaning compounds , medicines and hazardous items that can pose a danger to children.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Aaron Mabika
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 367700147
VISIT DATE: 07/06/2021
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LPA observed they were all locked up in cabinets in the kitchen and there were gates separating the kitchen from the day care area. The sharps are made inaccessible by being stored in a locked drawer and the cleaning detergents are in a latched-up drawer under the sink. LPA observed age appropriate safe toys in the day care room and in the backyard patio. LPA observed 2 baby cots and 5 napping mats on the premises. Per licensee children nap in the day care room. LPA observed all electrical outlets made inaccessible to children with safety covers. The floor, fixtures and counters were observed to quite clean. LPA tested hot water at a safe temperature between 105-120 degrees. Per licensee, there are no weapons or firearms on the premises. LPA did not observed any body of water. LPA observed age-appropriate toys like slide set, basketball hoops, water table, play house in the backyard. Artificial turf is used for cushion and there is a shade from a trimmed tree. The backyard is fenced and barricaded off from the off-limits area by a 5 feet perimeter mash wire for security.
Incidental Medical Services (IMS) were discussed. Per licensee, the facility is not currently providing IMS. LPA informed licensee to refer to IMS information in the 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 observed the required fire extinguisher (2A10BC) fully charged, smoke detectors and carbon monoxide devices tested operable. The First Aid Kit was observed complete with supplies and first aid manual. There is a surveillance system on premise.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Aaron Mabika
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 367700147
VISIT DATE: 07/06/2021
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LPA observed licensee has current Pediatric CPR and First Aid Training with expiration date (Jan 2022) 1 hour of nutrition training, (7) hours of Preventive Health and Safety Training. Licensee/Staff has proof of being immunized against influenza, pertussis and measles. Licensee provided a written statement declining the influenza vaccination. Per licensee transportation is not being provided. Per licensee 2 meals and 2 snacks are being provided to children.
LPA reviewed 3 children’s records. LPA reviewed the child care facility roster and the fire drills, earthquake drills log (done biannually) and documentation for both.
The following information was discussed with the licensee:
· Mandatory Forms for the children’s files and provider’s files.
· Requirements for fire drills, earthquake drills and documentation for both.
· Role and responsibilities of being a mandated reporter was discussed.
· Licensee was made aware that it is their responsibility to know and review updates/regulations and forms online at www.ccld.ca.gov as well as anyone who assists in providing care.
· The licensing department must have the facility’s phone number. If the phone number is changed, the licensing department must be notified.
· Licensee is aware that all adults 18 years and older living in the home or visiting for extended periods of time should have criminal background clearances. Failure to comply will result in Civil Penalty assessments.
· On January 1, 2018 or before March 30, 2018, a person who, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the on-line mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatedreporterca.com
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Aaron Mabika
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 367700147
VISIT DATE: 07/06/2021
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· AB 290 - for each new license issued, at least one director or teacher at a child care center or family child care home shall have at least one hour of childhood nutrition training;
· Senate Bill AB 2231 Civil Penalty Amount Changes. Changes Effective 7/1/2017.
· Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). **In addition; A copy of this report must be provided to the authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months.
· The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is in care.
· Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty · Licensee is made aware that Title 22 Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home, and in those areas of the family day care home where children are present (24/7 ban).
· **§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
· **Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
· Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed child care facility are aware of situations that present the greatest danger to children.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Aaron Mabika
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 367700147
VISIT DATE: 07/06/2021
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· State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.
· Licensee advised visit www.shotsforschool.org for Immunization information.
· Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov. Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe”.
· The facility was deemed to be operating in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes and no deficiencies were cited.
Exit interview conducted with Licensee Yamileth Mendoza. A copy of this report, notice of site inspection, Appeal Rights (LIC 9058), were given and explained during this inspection. Licensee’s signature on this form acknowledges receipt of these rights.
Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in visible location the authorized representatives of children.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Aaron Mabika
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
LIC809 (FAS) - (06/04)
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