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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020447
Report Date: 07/17/2023
Date Signed: 07/17/2023 10:55:12 AM

Document Has Been Signed on 07/17/2023 10:55 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: 10DATE:
07/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee Roxana MendozaTIME COMPLETED:
11:10 AM
NARRATIVE
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At approximately 08:40 a.m. Licensing Program Analyst (LPA)Veronica Martinez Garza conducted an unannounced case management inspection to address the deficiency observed by LPA Martinez Garza during visit conducted on this date. At the time of arrival licensing staff met with Licensee Roxana Mendoza.

LPA Martinez Garza observed a total of 09 children during this visit; 2 of the nine children were infants, 6 preschool children, and 1 school age child were present alone with licensee. Per Licensee, her assistant is on the way. This placed facility out of ratio. Licensee's assistant Josefina Camacho arrived at approximately 09:15 a.m. 1 more day care child arrived at approximately 09:49 a.m.

LPA informed licensee Roxana Mendoza, that this report dated 07/17/2023 document(s) one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.



Also,LPA Martinez Garza informed the licensee Roxana Mendoza to provide a copy of this licensing report dated 07/17/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. A copy of the LIC 9224 was provided.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted with Roxana Mendoza. Appeal rights were reviewed with the licensee and a copy was provided.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2023
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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Document Has Been Signed on 07/17/2023 10:55 AM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 07/17/2023 at 09:33 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 198020447

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/17/2023
Section Cited
CCR
102416.5(e)

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Staffing Ratio and Capacity. If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). The requirement is not met as evidenced by:
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Per Licensee, she works with variable schedules. Licensee will speak to parents and have them wait until my assistant arrives.
Licensee's assistant arrived 09:15 a.m.
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Upon arrival at 08:40 a.m., LPA observed Licensee was alone with 9 children
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Chico
LICENSING EVALUATOR NAME:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023


LIC809 (FAS) - (06/04)
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