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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020447
Report Date: 11/29/2022
Date Signed: 11/29/2022 11:06:12 AM

Document Has Been Signed on 11/29/2022 11:06 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
198020447
ADMINISTRATOR:ROXANA MENDOZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 928-6370
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
11/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Roxana Mendoza TIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced Case Management inspection on this day at approximately 10:05 AM. LPA met with Met with Roxana Mendoza, Licensee. The Licensee's assistant Teresa Heredia, was present during this inspection. There were 9 children present, 4 being infants.

The purpose of this visit was to ensure that the Licensee is in compliance with Title 22 regulations and that the citations issued on 11/04/22 were corrected by the Licensee.

Children's records were reviewed and inspected for all required forms. All children's forms were observed to be complete including the LIC 9224, Acknowledgement of Receipt of Licensing Reports. The Licensee's Assistant's file was reviewed and observed to be complete.

Infant Care: LPA observed 4 infants in care, 2 under 12 months. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months.


LPA Mora corrected all deficiencies on this date and issued Letters of Deficiency Citations Cleared to Licensee.

There are no citations being issued today.

Exit interview was conducted with Licensee. Appeal rights explained & provided.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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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