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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543909015
Report Date: 07/28/2021
Date Signed: 08/04/2021 09:46:56 AM

Document Has Been Signed on 08/04/2021 09:46 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MENDIOLA, CHERYL FAMILY CHILD CAREFACILITY NUMBER:
543909015
ADMINISTRATOR:MENDIOLA, CHERYLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 826-6028
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 12DATE:
07/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cheryl MendiolaTIME COMPLETED:
12:15 PM
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On 7/28/2021, Licensing Program Analyst (LPA) Kathy Pacheco conducted an unannounced annual inspection and met with Licensee, Cheryl Mendiola. A tour of the home was conducted and a census was taken. Current facility sketch reviewed and Licensee confirmed the living room, dining room, kitchen, hall bathroom and bedroom #3 are used for providing care and are accessible to day care children. Licensee stated she recently made bedroom #3 accessible to day care children. LPA inspected bedroom #3, which includes another bathroom that is accessible to day care children. LPA found bedroom #3 and the included bathroom to be safe for day care children to use. All other rooms are off-limits and are made inaccessible by use of spinner knobs. There were no firearms on the premises. There is an in-ground swimming pool in the backyard that is accessible to day care children. The swimming pool is fenced per regulation with a gate that is self-latching, self-closing, and opens away from the swimming pool. On the northwest side of the home, there is another fence that is located from the side of the home to the brick wall (that surrounds the perimeter of the backyard) that does not meet regulations. There is a bedroom window on the northwest side of the home that has access to the swimming pool. LPA advised Licensee the fence on the northwest side of the home needs to meet swimming pool fence regulations. Licensee stated she will have the fence changed immediately to meet swimming pool fence regulations. There is also a bedroom (#1) with a window that has immediate access to the swimming pool. This window has a lock installed on it, as well as, an alarm that sounds when the window is opened. Licensee stated she tests the alarm on the window once a week and documents each time. This will be further reviewed by management. Medications and other hazardous items were inaccessible to children. LPA did not observe any poisons in the home. There was no fireplace. The fire extinguishers, smoke detectors, and carbon monoxide detector met Community Care Licensing (CCL) regulations. The home was kept clean and orderly, with heating and ventilation for safety and comfort. There were no stairs in the home. Safe toys and play equipment were observed. Licensee had a working telephone and the above telephone number was verified. The outdoor play area in the backyard is fenced and there are no hazards to day care children. Licensee ensures that children in care are supervised at all times. Licensee is aware children shall not be left in parked vehicles and is aware car seats are used for transportation purposes only and are not used for sleeping children.(continued on next page)
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Kathy Pacheco
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2021
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MENDIOLA, CHERYL FAMILY CHILD CARE
FACILITY NUMBER: 543909015
VISIT DATE: 07/28/2021
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There are currently infants in care at the day care. LPA discussed Safe Sleep Regulations with Licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping. There are no objects hanging above or attached to the crib or play yard. Infants in care are not swaddled. Licensee to physically check on sleeping infants every 15 minutes and documents any signs of distress, to include but is not limited to: flushed skin color, increase in body temperature, restlessness, and labored breathing. Licensee stated although she checks on the infants, she was not aware she needed to document her checks. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is to be completed and in file for each infant up to 12 months of age. Licensee stated she was not aware of the new Individual Infant Sleeping Plan. Infants up to 12 months of age are placed on their backs for sleeping.

Adequate supervision was being provided during this inspection. Capacity as specified on the license was being maintained. Staff-child ratios were maintained. A sample of children’s records contained all emergency information specified by regulation. There were no excluded individuals present at this home. All adults who reside or work in the home had a criminal record clearance or exemption. Records indicated staff have proof of required immunization (Pertussis/Measles/Influenza) and/or written declaration declining flu shot, however, Licensee does not. Licensee's Mandated Reporter Training was completed on 9/13/2020. Licensee was reminded the Mandated Reporter Training shall be renewed every two years following the date on which it was initially completed. Licensee's pediatric CPR and First Aid expires on 11/14/2022.

Incidental Medical Services (IMS) are not currently provided. Licensee is aware that an IMS plan is required to be submitted to the Licensing Office if they provide any of these services. When any IMS is provided, an updated Plan of Operation that includes IMS, must be submitted to the Department. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA information line at (800) 514-0301 (voice), (800) 514-0383 (TDD/TTY), and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms, and Regulations.

(continued on next page)
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Kathy Pacheco
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MENDIOLA, CHERYL FAMILY CHILD CARE
FACILITY NUMBER: 543909015
VISIT DATE: 07/28/2021
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Business hours are Monday through Friday 7:30 AM to 5:30 PM and other hours as arranged.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations no deficiencies were observed today.

Exit interview was conducted with Licensee. Licensee was provided a copy of the Facility Evaluation Report (LIC 809), appeal rights, and the Notice of Site Visit form (LIC 9213). The LIC 809 is required to remain in the facility for public review and the LIC 9213 is required to be posted for 30 days.
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Kathy Pacheco
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
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