426216720-10-26-2023-17-CC-EBAY-CWZ2KZ-20231026172846

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216720
Report Date: 10/26/2023
Date Signed: 10/26/2023 05:28:59 PM

Document Has Been Signed on 10/26/2023 05:28 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 ESCAMILLA FAMILY DAYCARE		FACILITY NUMBER:	426216720
ADMINISTRATOR:	JANIE MENDOZA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 478-7813
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	10/26/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Janie Mendoza		TIME COMPLETED:	05:30 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 10/26/23, Licensing Program Analyst (LPA) Elvin Baddley conducted an announced Prelicense Inspection of the abovementioned home and met with Applicant Janie Mendoza. LPA informed Applicant of the nature and purpose of the inspection. Applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 3:00 AM-8:00 PM, Monday-Saturday. Licensee also intends to care for children 0 years of age to 12 years of age. Applicant was informed changes in licensing hours and/or the ages of children supervised and cared for can be altered upon notifying CCLD of the modification and/or change. LPA notes, no children are on site at the time of the inspection. LPA, in the company of Applicant, toured the the interior and exterior of the home in its entirety. The home is a three bedroom and two bathroom single story dwelling. The home's living room, kitchen, dining room, hallway bathroom and backyard will be used for child care services, while the remainder of the home is excluded. LPA observed a fire extinguisher (2A10BC) in the home which was purchased on 8/20/23. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has a number of smoke and carbon monoxide detectors. Smoke and carbon monoxide detectors were tested at 4:40 PM and found to be operable. LPA observed the home to be clean and orderly. The home has spacing and ventilation for children in care. The home has fireplace which is screened by glass. The home has central heating with vents on the ceiling. The bathroom to be used by children in care is observed to be clean and free of toxins. Cleaning compounds are stored in an elevated bathroom cabinet beyond the reach of children. Sharps are located in an elevated cabinet in the kitchen while medication is located in the home's bedrooms which are excluded from care. The backyard is enclosed by cider block and the entry/exit gate is secured. Footing in the area is varied. (CONT.809-C, Page 1)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MENDOZA FCC AKA ESCAMILLA FAMILY DAYCARE	FACILITY NUMBER: 426216720
	VISIT DATE: 10/26/2023

NARRATIVE

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The back yard is partitioned by a child safety gate to separate the area where children play and the area for the Applicant's personal use. There is a secure shed in the backyard which contains play equipment and household goods. Applicant is reminded to provide direct supervision of children when children are involved in outdoor activities away from the home. LPA observed no bodies of water on site.

LPA's record review revealed Applicant's Mandated Reporter training was completed on 6/2/23 (expiration 6/2/25), and Pediatric CPR/First Aid (EMSA approved) was completed on 7/27/23 (expiration 7/27/25). Applicant completed Preventative Health Training on 8/19/23. LPA reminded Applicant of obligation to maintain current training and certifications. The Applicant provided proof of control of property. Applicant does not have liability insurance. LPA provided Applicant LIC 282 form with respect to liability insurance. Applicant informed LPA the home has no ammunition or firearm on site.

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) or (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 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-andresources/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 of infant devices or their purchased equipment.

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, 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 (CONT. 809-C, Page 3)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

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 ESCAMILLA FAMILY DAYCARE	FACILITY NUMBER: 426216720
	VISIT DATE: 10/26/2023

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violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

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.

On this date, 8/7//23, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

Exit interview conducted and report was reviewed with the Applicant Janie Mendoza. The home meets Title 22 Division 12 requirements of a Small FCCH License, however Licensure is pending Administrative review of application.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC809 (FAS) - (06/04)

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