503911956-4-30-2026-04-CC-AMEA-DTMTGN-20260430144324

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503911956
Report Date: 04/30/2026
Date Signed: 04/30/2026 02:43:30 PM

Document Has Been Signed on 04/30/2026 02:43 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
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	MENDOZA, SERRINA FAMILY CHILD CARE		FACILITY NUMBER:	503911956
ADMINISTRATOR/ DIRECTOR:	MENDOZA, SERRINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 543-4740
CITY:	CERES	STATE: CA	ZIP CODE:	95307
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	04/30/2026
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:15 PM
MET WITH:	Licensee Serrina Mendoza		TIME VISIT/ INSPECTION COMPLETED:	03:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Aurelio Mendoza conducted an unannounced case management - other inspection at this licensed Family Child Care Home. LPA met with Licensee Serrina Mendoza, toured the home, and conducted a census. This visit was consultative and focused on reporting requirements for unusual incidents under Title 22, Division 12, Chapter 3.

LPA reviewed Title 22, Section 102416.2 – Reporting Requirements. The licensee was informed that the following must be reported to the Department: death of a child; any injury requiring medical treatment; any unusual incident or child absence that threatens a child’s health or safety; suspected child abuse or neglect; fires or explosions; communicable disease outbreaks; and poisonings.

LPA advised that reportable events must be reported to the Department by telephone or fax no later than the next working day. The licensee was specifically instructed to contact the Child Care Licensing - Fresno Regional Office - Officer of the Day at (559) 243-4588 to make the required verbal report. A written report must follow within seven (7) days using LIC 624 and include all required details (child’s information, date/time/nature of event, description, individuals involved, physician information if applicable, parent notification, and actions taken).

LPA emphasized that the licensee must notify the child’s parent or authorized representative as soon as possible, but no later than the same business day, for any injury or reportable event. The licensee was also reminded to maintain a copy of the report in the child’s file.

A current copy of the LIC 624 (Unusual Incident/Injury Report) was provided and reviewed during the visit.

Per Title 22, Division 12, Chapter 3, no deficiencies were cited. An exit interview was conducted with Licensee Serrina Mendoza. A copy of this report, Appeal Rights, and LIC 9213 (Notice of Site Visit) were provided and discussed. The Notice of Site Visit must be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Joseph Pacheco
NAME OF LICENSING PROGRAM ANALYST: Aurelio Mendoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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