434413520-5-20-2025-07-CC-SYUU-DGUPAB-20250520110827

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413520
Report Date: 05/19/2025
Date Signed: 05/20/2025 11:08:39 AM

Document Has Been Signed on 05/20/2025 11:08 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	MENDOZA, CELINA		FACILITY NUMBER:	434413520
ADMINISTRATOR/ DIRECTOR:	MENDOZA, CELINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 425-1729
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 6	CENSUS: 0	DATE:	05/19/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:36 AM
MET WITH:	CELINA MENDOZA		TIME VISIT/ INSPECTION COMPLETED:	11:15 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

Licensing Program Analyst (LPA), Shine Yu, conducted an unannounced Annual Inspection 08:36 am and was greeted and met with the Licensee, Celina Mendoza and her husband.

LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC610), Parents' Rights (PUB 393) and Earthquake Preparedness Checklist (LIC9148). Facility's operating days and hours are Monday to Friday 6:00 AM to 5:30 PM. LPA observed a current Children's roster. Licensee stated there are 6 school age children enrolled. The last fire drill was conducted on 04/10/2025. Present are licensee, her husband and mother who is just visiting this morning. There are no children present during the inspection.

LPA reviewed a random selection of 4 children's files and observed that notification of parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification forms are in each file.

LPA also reviewed the licensee's mandated reporter training certificate expires on November 7, 2025. And the Pediatric first Aid and CPR certificate expires August 28, 2025.

Licensee accompanied with LPA to tour the facility, including living room, dining room/kitchen, bathroom and family room. The Off limits areas inside the home are master bedroom, 2 bed rooms and garage. LPA observed the current fire extinguisher in the family room (2A10 BC), the smoke and carbon monoxide detector are in the hall way. The bathroom is clean and organized. There are age-appropriate toys in the family room and play yard for children. Licensee stated there is no firearm in the facility. There is no stairs in the facility. There is a depleted air, no water, plastic inflatable pool lied on the back yard. Licensee folded it up and put it aside immediately. Licensee stated only used it in the weekend. LPA stated there is PIN 25-01-CCP for new regulation for Swimming Pool Safety (AB 2866). Licensee acknowledged the pool regulation. The outdoor play area is enclosed with appropriate fence and safe for children.

Continue on page 2

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Syhshyan Yu
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

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

FACILITY NAME: MENDOZA, CELINA	FACILITY NUMBER: 434413520
	VISIT DATE: 05/19/2025

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

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.

Licensee stated there is no medication provided in the facility. 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/.

LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

The 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.

Continue on page 3

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Syhshyan Yu
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MENDOZA, CELINA	FACILITY NUMBER: 434413520
	VISIT DATE: 05/19/2025

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

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.

Exit interview conducted and report was reviewed with the licensee, Celina Mendoza.

The licensee also confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No citation was issued during today’s inspection and a copy of appeal right was provided to the licensee.

A Notice of Site Visit was given and must remain posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Syhshyan Yu
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025

LIC809 (FAS) - (06/04)

Page: 3 of 3