367700147-6-29-2022-12-CC-KZIS-CFUPGQ-20220629111843

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700147
Report Date: 06/29/2022
Date Signed: 06/29/2022 11:18:54 AM

Document Has Been Signed on 06/29/2022 11:18 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	MENDOZA FAMILY CHILD CARE		FACILITY NUMBER:	367700147
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 5	DATE:	06/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Licensee Yamileth Mendoza		TIME COMPLETED:	11:30 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) Zirbes met with Licensee, Yamileth Mendoza who guided analyst on a tour of the facility for the One Year Required inspection. This is single story home with three bedrooms, two bathrooms, kitchen, dining room, living room, laundry room, front/backyard and detached garage. Per Licensee the living room, hallway bathroom, and backyard are utilized for the family child care activities. Per licensee off-limit areas of the home are all three bedrooms, one bathroom located near the master bedroom, laundry room, kitchen, detached garage, front yard and a portion of the backyard. The off limits areas were inaccessible via child safety gates, key locked door knobs and child safety covers on the door knobs. Upon arrival, LPA observed five children in care (three infants and two older children) with the Licensee providing supervision. Currently living in the home are the Licensee, two adult household members and one minor child. All adults are associated and have eligible clearances. Current days and hours of operation are Monday through Friday 7am to 5pm. Physical Plant: The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. According to Licensee all cleaning products are stored in the locked laundry room. Sharp knives and household medications were stored in the off limits kitchen. The kitchen was inaccessible via a child safety gate. Per recorded documentation Fire/earthquake drills were last completed in June 2022, the fire extinguisher was serviced in February 2022. Safe and age appropriate toys, play equipment and materials were present. The smoke detector and carbon monoxide detector were operable. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. The dining room is the designated area for ill children in the child care. Report continued on page two

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

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: 06/29/2022

NARRATIVE

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Report continued from page one

Per Licensee, there are zero firearms stored in the home. The home has a fireplace which is blocked by a book case therefore the fire place is inaccessible to the children in care. The home has zero window blinds.

Bathroom: Toilet, sink, faucet were clean and operable. The following were inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. A changing area is in the living room of the home.

Outdoor: The backyard is divided into off limit and on limit areas. The off limit areas were made inaccessible via a 4ft gate. At the time of this inspection there were zero bodies of water on the premises. The on limit outdoor play area was inspected and play equipment was observed to be free of hazards. LPA observed a dramatic play house, toddler bikes, a tiny tots slide placed on a mat. LPA reminded the Licensee to regularly monitor the play equipment for potential hazards.

Per Licensee, the family has two dogs who are current on shots. Per Licensee, the dogs do not interact with the child care children.

CPR/First Aid expires 12/11/2023 and mandated reporter training expires on 05/22/2024.

Review of records to be maintained: LPA reviewed with licensee 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.

LPA reviewed six child files, the Licensees and two household member files. Based on LPAs record review the staff and child files were complete and included all required information.

Documents Provided and/or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep.

The following were observed: Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Emergency and Disaster Information (LIC610A).

Report continued on page three

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

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: 06/29/2022

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Report continued from page two

The following was discussed with the licensee:

Licensee reminded that 100% supervision is required at all times to children in care. Licensee was made aware that it is he/her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified

The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.

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.

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.

Based on LPAs record review there were zero citations issued today.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Yamileth Mendoza.

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

LIC809 (FAS) - (06/04)

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