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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192005786
Report Date: 03/18/2024
Date Signed: 03/18/2024 10:15:57 AM

Document Has Been Signed on 03/18/2024 10:15 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
192005786
ADMINISTRATOR:MENDOZA, NORMA I.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 564-6475
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Norma MendozaTIME COMPLETED:
10:30 AM
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On March 18, 2024, at 10:00 AM, Licensing Program Analyst (LPA) Angelica Wallin conducted an unannounced Case Management Inspection for the above facility license. During today’s inspection, LPA met with licensee, Norma Mendoza, who provided assistance. There were no children present when LPA arrived.

Licensee stated she has not had any children since the pandemic. LPA explained to licensee that they have an option of inactive status. Administrator stated that they would like to continue on inactive status at this time. LPA provided and obtained the LIC 9211 from the licensee during inspection.

Licensee agrees to the following:
I. Will not provide child care for which a license is required until license is reactivated.
II. Will continue to promptly pay the annual license fee.
III. Will inform Licensing office of any changes in the above dates prior to re-opening facility by submitting a new LIC 9211
IV. I will be in compliance with all licensing laws and regulations upon re-opening facility, including but not limited to:
· Ensuring all adult staff and residents, including children who turn 18 during the inactive period, have criminal record clearances
· Maintaining current CPR and First Aid certifications
· Maintaining a current fire extinguisher and functioning smoke alarms

Exit interview conducted and report was reviewed with licensee, Norma Mendoza. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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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