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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422755
Report Date: 04/07/2023
Date Signed: 04/07/2023 04:41:57 PM


Document Has Been Signed on 04/07/2023 04:41 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:HERNANDEZ, YEIMYFACILITY NUMBER:
013422755
ADMINISTRATOR:HERNANDEZ, YEIMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(617) 901-3114
CITY:OAKLANDSTATE: CAZIP CODE:
94611
CAPACITY:14CENSUS: 10DATE:
04/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Claudia Santana RodriguezTIME COMPLETED:
04:50 PM
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On 4/07/2023 at 2:15pm Licensing Program Analyst (LPA) Diana Campos conducted an unannounced Annual Required inspection at Yeimy Hernandez Family Childcare Home. LPA met with assistant Claudia Santana Rodriguez and explained the purpose of today's inspection. LPA was granted the inspection authority to enter the Home. The family childcare home days and hours of operation are Monday to Friday 8:00am-5:00pm. Present in the home at time of inspection were 3 assitants and 9 preschoolers in care.

Assistant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Indoor Space: At 2:30pm A health and safety tour of inside the home was done. LPA toured the premises with assistant. The home is sanitized and orderly in compliance with Title 22 Regulations at this time. There is a 3A40BC fire extinguisher, smoke and carbon monoxide detector in the home. The home is a two story house consisting of 3 bedrooms, 2 bathrooms, living room, den, kitchen and a garage



The OFF-LIMIT areas are the entire upper level of home, the bedroom on the first level, kitchen and the garage. These areas are inaccessible to children in care by closed locked doors and visual supervision at all times. there is a child proof gate at bottom of stairs.
IN-USE The den, living room, bathroom and backyard is used as the primary areas for day-care.) Medicines, cleaning products, sharp objects are stored inaccessible to children in care during today's inspection.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2023
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HERNANDEZ, YEIMY
FACILITY NUMBER: 013422755
VISIT DATE: 04/07/2023
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 LPA reminded assistant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Assistant states that there are two dogs in the home. Licensee states there are no arms and ammunition stored in the home. The fireplace is blocked to prevent access to children in care, and the home maintains a working telephone.
Outdoor Space: AT 2:50pm LPA toured the outdoor area (backyard) and observed it was fenced. LPA observed there is a hot tub in the backyard which is covered and locked to prevent access by children in care.
Children files and Facility files were reviewed. Facility contained Children's Roster, pediatric CPR and first aid expires 08/2023.

This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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

LPA discussed the safe sleep regulations with assistant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed assistant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

No deficiencies were cited during today's inspection.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Assistant Claudia Santana Rodriguez.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023
LIC809 (FAS) - (06/04)
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