<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215159
Report Date: 10/12/2021
Date Signed: 10/12/2021 01:56:02 PM

Document Has Been Signed on 10/12/2021 01:56 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:MENDOZA FCC AKA LIL WIZARDS DAY CAREFACILITY NUMBER:
566215159
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
10/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Alberto MendozaTIME COMPLETED:
02:01 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On October 12 2021 at 12:15 PM Licensing Program Analyst (LPA) Austin Rios conducted an unannounced annual inspection. LPA conducted Covid-19 screening questions prior to entering the home. LPA met with licensee Martin Fernandez and discussed the nature and purpose of the inspection. Together both licensee and LPA conducted a tour of the home inside and outside. There was two children in care at the time of the inspection.

The home is a single story residence and licensee uses the living room, kitchen, family room, two restrooms, and backyard for the day-care. LPA observed a lock on all bedroom doors making it inaccessible to children in care. There was a swimming pool in the backyard. LPA observed a 5' plastic mesh fence around this pool with a door that swings away from the swimming pool. LPA observed firearm and ammunition stored separately in a safe in master room closet up high. LPA did not observe toxins/hazards accessible to children in care. In the living room, LPA observed a fireplace with screen in front of it preventing children from having access. There are age appropriate toys and furniture readily accessible to children. The backyard is fully enclosed with a concrete wall. Licensee has age appropriate toys and play structures in the backyard in good condition and free of hazards. LPA observed there was ample amount of shade available for children.

The home has a working smoke and carbon monoxide detector. A 2A10BC fire extinguisher was observed in the family room with a purchase date of 3/30/2021. Licensee has a valid Pediatric CPR/First Aid certificate with an expiration date of 6/17/2023. Licensee has AB 1207 Mandated Reporter Training Certificate on file expiring on 11/13/2022.

Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MENDOZA FCC AKA LIL WIZARDS DAY CARE
FACILITY NUMBER: 566215159
VISIT DATE: 10/12/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
All required forms are prominently posted for parent's or authorized representatives to view in the family room. A roster of children in care was observed current and complete. A sampling of children's records were reviewed and found complete. LPA observed Identification and Emergency Notification forms (LIC 700). Licensee has a dog and all vaccines are current.

LPA spoke with licensee regarding safe sleep regulations. Licensee does not currently have any infants enrolled.

Incidental Medical Services (IMS) was discussed. Licensee states currently no children with IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at:http://www.ada.gov/childqanda.htm

No deficiencies were cited during today's visit.



THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2