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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216874
Report Date: 04/16/2024
Date Signed: 04/16/2024 02:03:38 PM

Document Has Been Signed on 04/16/2024 02:03 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:MENA FAMILY CHILD CAREFACILITY NUMBER:
426216874
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/16/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Rosalba MenaTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 04/16/2024, Licensing Program Analyst (LPA) Martina Jimenez conducted an announced, Pre-licensing inspection for a Small Family Child Care Home (FCCH) license. LPA met with Rosalba Mena, applicant, and Soledad Mena, applicant's daughter. The purpose of the inspection was discussed and together LPA and Applicant toured the inside and outside of the home. There were no children in care at the time of the inspection.

The applicant is requesting a small family childcare license. The home is a two (2)story home, which consists of two(2) ADU's, each ADU consist of two(2) bedrooms, one (1) bathroom, and kitchen. The main home consist of three (3) bedrooms, two(2) bathrooms, living room, kitchens, dining area, laundry room, enclosed patio and outdoor play area. LPA notes that the day care services will occur in the living room, dining area, kitchen, bathroom, and outdoor play area. LPA observed the two (2) bedrooms, and one (1) bathroom secured with safety knob covers, making these areas inaccessible to children in care.

LPA notes, the door located in the enclosed patio leading to the upstairs ADU was unsecured at the time of the inspection. The first ADU is located on the right side of the home. There is a stairwell leading to the upstairs ADU.
Continues on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
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: MENA FAMILY CHILD CARE
FACILITY NUMBER: 426216874
VISIT DATE: 04/16/2024
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The second ADU is located in the back of the home. The entrance to the second ADU is located in the outdoor children's play area. Per applicant the second ADU is also a two(2) bedroom one(1) bathroom with a kitchen ADU. The second ADU was secured a the time of the inspection. LPA was unable to inspection the second ADU.

LPA observed the FCCH is fully equipped to meet the needs of children in care. LPA observed that the FCCH is clean and orderly. In addition, there is plenty of ventilation for the children in care. LPA did not observe any toxins nor hazards items accessible to children in care.

LPA observed that knives and medication are stored in an elevated cabinet in the kitchen and bedroom #1, inaccessible at the time of the inspection. Cleaning compounds were observed an elevated laundry room cabinet that was secured at the time of the inspection making the cleaning compounds inaccessible to children in care. The bathroom to be
used for children in care was observed to be clean and free of toxins. LPA observed child size furniture and material for activities throughout the home in areas that will be accessible to children in care.

LPA and applicant toured the outdoor play area, LPA advised the applicant children must never be unsupervised while the children are at the play area.

CONTINUES ON LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
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: MENA FAMILY CHILD CARE
FACILITY NUMBER: 426216874
VISIT DATE: 04/16/2024
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LPA observed the exits to be secured. LPA observed there is shading to afford the children in care. In addition, Filtered water will be accessible by means of water jug with individual water cups. The play area has age-appropriate toys and day-care equipment. LPA and applicant discussed active supervision when children are in the outdoor yard.

· No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

· All adults living and working in the home shall be made of aware of the Department inspection rights authority.



There are twelve (12) adults living in the home, which three (3) adults residing in the home have been fingerprint cleared. There are nine(9) adults residing in the home who have not completed the fingerprint clearance.

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 violation, for a maximum of 30-days per person will be assessed if this regulation is violated.
CONTINUES ON LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
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: MENA FAMILY CHILD CARE
FACILITY NUMBER: 426216874
VISIT DATE: 04/16/2024
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LPA observed a regulation 2A10BC fire extinguisher that was purchased on 04/30/2023. Licensee is reminded to service or purchase the fire extinguisher yearly. LPA observed applicant test a combination smoke and carbon monoxide detectors in the home at 12:31 PM and were functioning at the time of the inspection. Applicant stated that there are no weapons or ammunition in the home. Applicant stated she does hold a foster family license.

Applicant completed the Family Child Care Orientation on 8/16/2022. Applicant completed the Preventative Health & Safety on 4/13/2023. Applicant is current with immunization required per SB 792. Applicant Pediatric First Aid/CPR certificate is valid until 04/21/2025. Applicant’s Mandated Reporter Training certificate is valid until 04/30/2025. The applicant, provided proof of control of property. Control of property was verified via receipt of lease agreement. Because the applicant, rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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.
Continues on LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
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: MENA FAMILY CHILD CARE
FACILITY NUMBER: 426216874
VISIT DATE: 04/16/2024
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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. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant, and discussed the Child Care Licensing Safe Sleep web page 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.

On this date, 04/16/24, 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
addresses. 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.

CONTINUES ON LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: MENA FAMILY CHILD CARE
FACILITY NUMBER: 426216874
VISIT DATE: 04/16/2024
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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. 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 platforms. 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.

Applicant was made aware the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

The FCCH license is pending verification of the following corrections :

1. Criminal Record Clearance for Jorge Cruz Torrez, Alejandra Vazquez Lopez, Manuel Gerardo Cruz Soriano, Brigida Rios Medina, Rocio Jasmin Rojas Cruz, Florencio Martinez, Susanna Martinez &Edgar Martinez
2. Tuberculous test result within the last 12 months for Jorge Cruz Torrez, Alejandra Vazquez Lopez, Manuel Gerardo Cruz Soriano, Brigida Rios Medina, Rocio Jasmin Rojas Cruz, Florencio Martinez, Susanna Martinez &Edgar Martinez
3. Secured bedroom door to bedroom #3 & side door of enclosed patio leading to the ADU
4. Removed or secured garden tools, open beer cans, open cans of energy drinks, soap, ect.. in the out door play area.
5. Updated Facility sketch to include ADU #1 & ADU #2
6. Napping equipment
7. Final Approval from the City of Santa Maria for the two(2) ADUs

CONTINUES ON LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: MENA FAMILY CHILD CARE
FACILITY NUMBER: 426216874
VISIT DATE: 04/16/2024
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The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Jimenez. A notice of site visit was given to applicant, and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the applicant, Rosalba Mena.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
LIC809 (FAS) - (06/04)
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