367700147-3-25-2024-12-CC-KZIS-D3PPYB-20240325114340

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700147
Report Date: 03/25/2024
Date Signed: 03/25/2024 11:43:51 AM

Document Has Been Signed on 03/25/2024 11:43 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	MENDOZA FAMILY CHILD CARE		FACILITY NUMBER:	367700147
ADMINISTRATOR:	MENDOZA, YAMILETH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 954-8145
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92405
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	03/25/2024
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Licensee Yamileth Mendoza		TIME COMPLETED:	11:50 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	On March 25, 2024 at 09:00 a.m., Licensing Program Analyst (LPA) Zirbes met with Licensee Yamileth Mendoza for the purpose of conducting the annual continuation inspection. Upon arrival, LPA observed seven preschool children and one infant in care. LPA was advised by the Licensee that one additional minor household member was present in the off limit bedrooms. Therefore, there were a total of eight children present with the Licensee and staff 1 (S1) providing supervision. During the inspection, LPA reviewed a total of five child files. At the time of LPAs review, the Licensee could not find child 1 (C1) file. During the inspection, the Licensee was able to obtain all required documents for C1 file. LPA reminded the Licensee to ensure a complete and current child file was available for all children enrolled in the child care. Proof of C1's past 15 minute safe sleep checks were not able to be reviewed during this inspection. The Licensee subscribes to Procare, which is a childcare App that tracks the activities of the infants. During this inspection, LPA observed the Licensee using the App to document the safe sleep checks, however the Licensee was unable to show documentation of past safe sleep checks. Licensee stated there have been a few issues with the ProCare app. LPA reminded the Licensee of the requirement to have documentation of the safe sleep checks. LPA was able to review past handwritten safe sleep checks during this inspection. Technical advisories notices were issued. LPA reviewed two staff files and three household member files. Staff 1 (S1) did not have documentation of the measles immunization. S1 has been employed since 10/30/2023. A type B citation was issued. 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. Per conversation with the Licensee the last fire drill occurred in January 2024, however Licensee was unable to provide LPA with written documentation showing the drill was completed. A technical advisory notice was issued. Report continued on page two

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 367700147
	VISIT DATE: 03/25/2024

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
26
27
28
29
30
31
32

Report continued from page one

The following was discussed with the licensee:

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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-andresources/
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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Yamileth Mendoza, confirmed that there are no Registered Sex
Offenders living in the facility and LPA completed the RSO profile in FAS.

Report continued on page three

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

LIC809 (FAS) - (06/04)

Page: 2 of 6

Document Has Been Signed on 03/25/2024 11:43 AM - It Cannot Be Edited

Created By: Kendal Zirbes On 03/25/2024 at 11:08 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 367700147
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in one of two staff files reviewed did not have documentation of the measles immunization, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/08/2024
	Plan of Correction
1 2 3 4	Per Licensee, the staff will obtain proof of the measles immunization and the documentation will be added to the staff file. Licensee will check each staff file prior to employment to ensure all required documents are present.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Lady King

LICENSING EVALUATOR NAME:

Kendal Zirbes

LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

LIC809 (FAS) - (06/04)

Page: 3 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MENDOZA FAMILY CHILD CARE	FACILITY NUMBER: 367700147
	VISIT DATE: 03/25/2024

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
26
27
28
29
30
31
32

Report continued from page two

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on LPAs record review one type B citation and two technical advisory notices issued.

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

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

LIC809 (FAS) - (06/04)

Page: 6 of 6