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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700262
Report Date: 06/09/2022
Date Signed: 06/09/2022 11:05:41 AM


Document Has Been Signed on 06/09/2022 11:05 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:HERNANDEZ, WENDYFACILITY NUMBER:
015700262
ADMINISTRATOR:HERNANDEZ, WENDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 661-7553
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:14CENSUS: 6DATE:
06/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Wendy HernandezTIME COMPLETED:
11:30 AM
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On June 9, 2022 at 8:30 AM., Licensing Program Analyst (LPA) Elimika Woods met with licensee Wendy Hernandez for a Required 1 Year Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection was the licensee's fingerprint cleared assistant, S. Miller and six (6) children, four (4) infants and two (2) preschool age children. Licensee stated that the facility operates from Monday to Friday 8:30 AM to 5:00PM.

LPA toured the facility to conduct a Health and Safety inspection. This single story home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. The Isolation area will be a bedroom (1), away from other children in care.

On-limit-areas include: Living and dining room, bathroom, bedroom (2), back and front yard, and bedroom (1) across the hallway from the bathroom

Off-limit-areas include: Garage, and kitchen

The off-limits are will be made inaccessible by closed and/or locked doors and visual supervision. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection.

There is a wall heater in the living room that is blocked to prevent children access . Per licensee, there are no firearms in the home. The home has a fully charge 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone and first aid kits. The licensee is in compliance with the immunization laws which pertains to all day care providers. The licensee's Health and Safety training is completed, and CPR and First Aid certificate is current and expires 07/2023. The licensee has completed and received a certificate in mandated reporter training on 06/30/21.

See 809-C for continuance
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022
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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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: 06/09/2022
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The OUTDOOR PLAY area is the front-yard/driveway area as well as a backyard and the licensee is aware she must have 100% visual and physical supervision when children are outdoors in the front yard area. The outdoor area has age appropriate toys and furnishings that LPA observed to be clean and free from defects and dangerous conditions. During today's inspection, there are no play structures which are required to be anchored.

At 9:30 AM LPA requested and reviewed the file of three (3) children in care. All children files contained Immunization, Parent's Rights, and Medical Consent forms. The facility roster was reviewed, and copies were obtain. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 06/09/22. The licensee is in ratio today. All required forms are posted and visible for public review.

California Law requires Family Child Care Home 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 inspected the medication, which is stored in a safe place that is inaccessible to children in care. Each of the medications has an unaltered label with the child’s name and date of issuance.

LPA discussed the Items that are not permitted in Licensed day-care facility: Infant bouncers, saucer chairs, johnny jumpers, baby walkers & drop-down cribs. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. LPA discussed the safe sleep regulations with licensee 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 licensee 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.

See 809-C

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC809 (FAS) - (06/04)
Page: 2 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: HERNANDEZ, WENDY
FACILITY NUMBER: 015700262
VISIT DATE: 06/09/2022
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LPA informed the licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The licensee was also reminded that CPR/First Aid is renewed every two years. Mandated Reporter Training is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Licensee 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Wendy Hernandez.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC809 (FAS) - (06/04)
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