367700147-8-9-2022-12-CC-KZIS-CH5UB2-20220809152538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700147
Report Date: 08/09/2022
Date Signed: 08/09/2022 03:25:52 PM

Document Has Been Signed on 08/09/2022 03:25 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 CARE		FACILITY NUMBER:	367700147
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 3	DATE:	08/09/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Licensee Yamileth Mendoza		TIME COMPLETED:	03:35 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 8/9/2022 Licensing Program Analyst (LPA) Zirbes, conducted a Case Management inspection with Licensee, Yamileth Mendoza. The purpose of the case management inspection was to assess the home for a capacity increase and ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety and statutory requirement. The licensee is requesting to provide care for a Large family childcare home (FCCH) for the capacity of 14 children. Fire clearance was granted on 8/2/2022. During the inspection, three children total (two infants and one child over two years of age) were present. The Licensee was the only person providing supervision at the time of the inspection. Per licensee, currently residing in the home is licensee, two adults and one minor child. The home is described as follows: 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, dining room, hallway bathroom, and backyard are utilized for the family child care activities. The off-limits areas consists of: all three bedrooms, one bathroom located in 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 doors, and child safety covers on the door knobs. The home has a fire place in the living room. Currently a shelving unit is placed in front of the fireplace. Therefore the fire place was inaccessible to the children in care. The home has central heating and air conditioning. Indoor: Living room: This area was furnished with two couches, fireplace, rocking chair, television and dramatic play corner. LPA observed low shelving units filled with dinosaurs, push and pull toys, and additional items for the children in care. Dining Room: Furnished with a table and four chairs and an additional child size table and six hairs. LPA also observed a high chair. Licensee expressed a willingness to purchase additional items to meet the needs of additional children to whom care is provided. . Report continued on page two

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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: 08/09/2022

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Outside: 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. Zero chemicals or hazardous products were observed in the outdoor play area.
Napping equipment: LPA observed two play yards and five mats. LPA observed each of the children bedding was stored in individual plastic bags. Per Licensee, the children will nap in the living room. Licensee stated they are willing to purchase additional napping equipment if necessary to met the needs of the children in care.
Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
Weapons or Firearms: Per Licensee, there are no firearms in the home.

Cleaning compounds: Stored in the off limits laundry room and hallway closet. The laundry room door and closet door were equipped with a key locks therefore the cleaning products were inaccessible at the time of this inspection. LPA reminded the Licensee that the child care license allows the provider to care for children up to the age of 12. Therefore, the licensee had to ensure all cleaning products were inaccessible to children of all ages.
The smoke detector and a carbon monoxide detector: located in the hallway of the home. The home has a pull down fire alarm in the living room. Items were operable.
Fire extinguisher (2A10BC) There was a fully charged fire extinguisher (2A10BC); which meets fire marshal standards.
Pet: The family has two dogs who are current on shots. Per Licensee, the dogs do not interact with the child care children.
Kitchen (OFF Limits): The kitchen was made inaccessible to the children in care via a child safety gate which blocks the entrance to the kitchen. All sharp utensils, knives, medications, alcohol was in cabinets equipped with key locks. The refrigerator, dishwasher, stove, microwave, etc., are clean. The kitchen was clean, orderly, and free of hazardous items. The Licensee prepares meals and snacks for the children in care.
Report continued on page three

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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: 08/09/2022

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Laundry room (Off limits): located off of the kitchen. The laundry was made inaccessible to the children in care via a key lock.

Bedroom #1 (Master Bedroom and Bathroom) (Off limits): Located off of the kitchen. The bedroom was furnished with bed, and personal belongings. The door leading to the master bedroom and bathroom was locked with a key lock.
Bedroom #2: (Off limits): located off of the hallway. The bedroom was furnished with bed, and personal belongings. The door leading to the bedroom was locked with a key lock.
Bedroom #3: (Off limits): located off of the hallway. The bedroom was furnished with bed, and personal belongings. The door leading to the bedroom was locked with a key lock.

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.

On January 1, 2018, or before March 30, 2018, a person who is a licensed childcare provider, administrator, or employee of a licensed child day care facility shall complete the online mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatereporterca.com

**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 childcare facility are aware of situations that present the greatest danger to children.
Report continued on page four

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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: 08/09/2022

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Licensee 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 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.

LPA reviewed the Licensee file and one child file. All required forms were within the files at the time of this inspection. Per LPAs review the Licensee CPR/First Aid expires 12/11/2023 and mandated reporter training expires on 05/22/2024.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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

Report continued on page five

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: 08/09/2022

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LPA and Licensee discussed the large family home capacity regulations. LPA also discussed the personal requirements for the new staff person.

There were no deficiencies cited today. As a result of this inspection, the home does meet Title 22 Regulations. Capacity increase is pending final approval from the Licensing Program Manager.

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: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

LIC809 (FAS) - (06/04)

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