015700262-7-27-2021-52-CC-EWOS-C5BPHK-20210727112003

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700262
Report Date: 07/27/2021
Date Signed: 07/27/2021 11:20:10 AM

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	HERNANDEZ, WENDY		FACILITY NUMBER:	015700262
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	07/27/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Wendy Hernandez		TIME COMPLETED:	11:45 AM

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 07/27/2021 at approximately 8:20 AM, Licensing Program Analyst (LPA) Elimika Woods met with applicant Wendy Hernandez for an ANNOUNCED PRE-LICENSING INSPECTION. Present for this visit was applicant Wendy Hernandez, and her two (2) school age daughter's. LPA disclosed the purpose of the inspection and was granted entry into the facility by the applicant. The home was toured to conduct a Health and Safety Inspection. The facility currently plans to operate 8:30 AM until 5:30 PM., Monday through Friday On-limit-areas include: Living and dining room, bathroom, bedroom (1), backyard, front yard Off-limit-areas include: bedroom (2) across from bathroom, garage, and kitchen This one story home which consists of two bedrooms, one bath, kitchen, garage, backyard, living and dining room. The home is neat and clean with heating and ventilation for safety and comfort. The ISOLATION AREA will be the dining room away from children in care. The off-limit area will be inaccessible by child safety gates, closed and/or locked doors and visual supervision. The outdoor play area is the fully fenced backyard and LPA observed that it is free from defects or dangerous conditions. The front yard is also used for play , and the applicant is reminded to have 100% visual supervision since the outdoors is unfenced. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during today inspection. There are ample age appropriate toys, learning materials, and equipment that appear to be safe and in good condition. During today's inspection, there are no play structures which are required to be anchored. See 809-C for continuance

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021

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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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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: HERNANDEZ, WENDY	FACILITY NUMBER: 015700262
	VISIT DATE: 07/27/2021

NARRATIVE

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The home has a fully charge 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone and First Aid Kits. The applicant’s Health and Safety training is completed, and CPR and First Aid certificate is current and expires 07/2023. The applicant completed and received a certificate in mandated reporter training on 06/30/21. The applicant is in compliance with the immunization laws which pertains to all day care providers.

There is a fireplace that is blocked to prevent children access. Per applicant, there are no firearms in the home. A copy of the lease was reviewed and shows control of property. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed.

Incidental Medical Services (IMS) policy was discussed. 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) too-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 informed the applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the applicant to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The applicant was also reminded that Mandated Reporter Training is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

See 809 C

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021

LIC809 (FAS) - (06/04)

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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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: HERNANDEZ, WENDY	FACILITY NUMBER: 015700262
	VISIT DATE: 07/27/2021

NARRATIVE

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LPA Woods provided a copy of Safe Sleep-in Child-Care brochure, a handout "What Does A Safe Sleep Environment Look Like?" and a copy of the new California Car Seat Law Changes.

California Law requires Family Child Cares licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail.

Roster of the children must be properly maintained and fire/disaster drill every six months must be documented. The applicant is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. The applicant was provided information regarding effects of Lead Exposure and testing requirements (Assembly Bill 2370).

This home is recommended for licensure on 07/27/21. This report shall remain on file for 3 years. Exit interview conducted applicant.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021

LIC809 (FAS) - (06/04)

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