434408105-6-4-2024-07-CC-MMOO-D5WQ26-20240604114639

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408105
Report Date: 06/04/2024
Date Signed: 06/04/2024 11:48:11 AM

Document Has Been Signed on 06/04/2024 11:48 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	MENDOZA, FRANCES		FACILITY NUMBER:	434408105
ADMINISTRATOR/ DIRECTOR:	MENDOZA, FRANCES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 509-9702
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 13	CENSUS: 13	DATE:	06/04/2024
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:10 AM
MET WITH:	Frances Mendoza		TIME VISIT/ INSPECTION COMPLETED:	12:00 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 June 4, 2024 at 9:10 AM, Licensing Program Analyst (LPA), Marilou Monico, conducted an unannounced Annual Required Inspection. LPA met with Licensee, Frances Mendoza, and explained to her the nature of today's visit. Also present in the home were licensee's husband, two adult assistants, and 12 daycare children: 2 infants and 10 preschool age. All required posting materials were posted. The daycare is open Monday thru Friday from 7:00 AM to 5:30 PM. There are no active waivers or exceptions for this facility. At 9:45 AM, another preschool age child arrived in the home. The daycare is a one storey home with three (3) bedrooms and two (2) bathrooms. Per Licensee, the adults that reside in the home are herself, her husband, and her granddaughter. LPA obtained a copy of current children's roster during the inspection. Fire/disaster drill was conducted on January 2, 2024. LPA observed a fully charged 3A40BC fire extinguisher and functioning smoke and carbon monoxide detectors. Licensee states that there are no weapons or firearms in the home. 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 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 Licensee, Frances Mendoza, 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. Continuation on next pages:

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MENDOZA, FRANCES	FACILITY NUMBER: 434408105
	VISIT DATE: 06/04/2024

NARRATIVE

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Off limit areas inside the home are: bedroom #2 and bedroom #3. LPA observed that the home is clean and orderly. Cleaning products, sharp objects, and other items that are dangerous to children were stored inaccessible. LPA sufficient age-appropriate materials, toys, and play equipment in the home. The children's bathroom is clean, sanitary, and operable. The home has a working telephone which is (408) 509-9702. There are no off limit areas outside the home.

LPA reviewed 13 children's files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), sleep log for children under 2 years old, and Immunization Records. Licensee carries daycare insurance.

LPA reviewed two (2) assistant files for the following records: Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), and TB test. Licensee and her adult assistants have immunizations in measles, pertussis and flu, Mandated Reporter Training, and Pediatric CPR/First Aid. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years.

LPA provided and 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 reminded 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..

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Continuation on next page:

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MENDOZA, FRANCES	FACILITY NUMBER: 434408105
	VISIT DATE: 06/04/2024

NARRATIVE

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Licensee, Frances Mendoza, 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&R's) throughout California.

As a result of today's inspection, Type B deficiency was cited on the following page.

Exit interview conducted and report was reviewed with Frances Mendoza, Licensee.

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

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/04/2024 11:48 AM - It Cannot Be Edited

Created By: Marilou Monico On 06/04/2024 at 11:15 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MENDOZA, FRANCES	FACILITY NUMBER: 434408105
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.5(d)(2)

Staffing Ratio and Capacity

(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation, the licensee did not comply with the section cited above by having 13 children present in the home: 2 infants and 11 preschool age which poses a potential health, safety or personal rights risk to persons in care. One of the children just started on 06/03/24 and the child's parent came to pick up the child during the inspection.
	POC Due Date: 06/06/2024
	Plan of Correction
1 2 3 4	Licensee states she will submit a written plan by 06/06/24 to ensure that the required ratio and capacity are maintained at all times.

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:

Joel Segura

LICENSING EVALUATOR NAME:

Marilou Monico

LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024

LIC809 (FAS) - (06/04)

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