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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216290
Report Date: 04/25/2022
Date Signed: 04/25/2022 05:22:03 PM

Document Has Been Signed on 04/25/2022 05:22 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:MENDOZA FCC AKA HAPPY WORLD DAYCARE, INC.FACILITY NUMBER:
426216290
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
04/25/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Yesenia MendozaTIME COMPLETED:
05:30 PM
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On 04/25/22, at 2:45 PM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Prelicensing Inspection of the abovementioned home and met with Applicant, Yesenia Mendoza. LPA informed Applicant of the nature and purpose of the inspection. LPA notes there was one teenage child present on site at the time of the inspection. Applicant informed LPA that teenage child is Applicant's daughter. Applicant informed LPA of the intention to maintain operating hours of a Small Family Child Care Home (FCCH) from, Monday- Sunday from 5am-11:59 pm. The Applicant also Informed LPA of the intention to provide care for children birth to 13 years of age.

LPA toured the interior and exterior of the home with the Applicant. Applicant reports that two (2) adults live in the home, both adults fingerprints have cleared. LPA notes that child care services will occur in the day care room that is separated from the home by means of a locked door. Applicant stated that parents will enter the day care room through the side of the home. LPA notes that the main house which consists of two bedrooms, bathroom, kitchen/dinning/living room area are off-limits. LPA observed the bathroom to be used for children care is observed to be clean and free of toxins. All medication in the home is stored in an elevated cabinet in the kitchen which beyond the reach of children. Likewise, LPA observed all cleaning compounds in the home are stored under the sink of the main home that is off-limits to children in care. LPA observed sharps on a shelf in a kitchen that is locked which is beyond the reach of children. LPA observed that there is another unit in the premises. Applicant reported that Applicant is renting the home and has no access to the other unit in the premises. LPA and Applicant toured the exterior of the additional unit. LPA observed that unit is identified as 515 Church St. Unit B.

LPA observed a required fire extinguisher 2A10BC in the home which was purchased on 04/25/22. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has smoke and carbon monoxide detectors which were tested at 2:55 PM and found to be operable.
CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MENDOZA FCC AKA HAPPY WORLD DAYCARE, INC.
FACILITY NUMBER: 426216290
VISIT DATE: 04/25/2022
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LPA observe the outdoor yard to be completely fenced. Play structures and equipment were observed to be in good conditions and are age appropriate. LPA notes that the outdoor yard has plenty of shade and Applicant stated that more shade will be added in form of canopy. Applicant stated drinking water will be assessable to children by individual water bottles.

LPA's record review revealed Applicant completed Preventative Health training on 02/21/20. Further, Applicant completed Mandated Reporter training on 03/09/22, and Pediatric CPR/First Aid (EMSA approved) on 01/05/22. Applicant completed Family Child Care Orientation on 02/13/20. LPA reminded Applicant of obligation to maintain current training and certifications. LPA reviewed Applicant's control of property document (Lease Renewal Addendum). Applicant does not have liability insurance for the home as of yet but plans on getting insured. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282).



LPA reviewed with Applicant 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.

Applicant 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 applicant 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 Applicant 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.

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.

CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MENDOZA FCC AKA HAPPY WORLD DAYCARE, INC.
FACILITY NUMBER: 426216290
VISIT DATE: 04/25/2022
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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.

Exit interview conducted and report was reviewed with the Applicant, Yesenia Mendoza. The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license will be noted as the present, 04/25/22.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022
LIC809 (FAS) - (06/04)
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