103907919-8-12-2021-04-CC-RMAS-C5TNAX-20210812101817

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103907919
Report Date: 08/12/2021
Date Signed: 08/12/2021 10:18:21 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	HERNANDEZ, MARIA FAMILY CHILD CARE		FACILITY NUMBER:	103907919
ADMINISTRATOR:	HERNANDEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 289-3185
CITY:	SANGER	STATE: CA	ZIP CODE:	93657
CAPACITY:	14	CENSUS: 6	DATE:	08/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Maria Hernandez		TIME COMPLETED:	10:30 AM

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On 08/12/2021 Licensing Program Analyst (LPA), Rene Mancinas conducted an unannounced Annual Required Inspection and was met by Licensee, Maria Hernandez. Days and hours of operation are Monday through Friday 05:00am to 05:00pm.

LPA reviewed current facility sketch and LPA toured the home inside. Licensee confirmed the living room, kitchen, dining area, and children’s restroom are accessible to children in care. Licensee stated the backyard is off limits, but has future plans of making accessible. LPA informed Licensee to contact the Department to report any changes regarding accessible areas. All other rooms/areas are off-limits and made inaccessible by use of children safety gate/ child proof devices. There is a pet at this home. Licensee understands the responsibility of any action taken by pet involving day care children. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition at this home. No poisons were observed during the inspection.

There is a that is screened off via a safety glass to prevent access to children. There is a working fire extinguisher, smoke detector, carbon monoxide detector, and adequate heating and ventilation for safety and comfort. Safe toys and play equipment are observed. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. The home has working telephone service and LPA confirmed the phone number.

LPA discussed Safe Sleep Regulations with licensee. Licensee understands she is to physically check on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is to be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are to be placed on their backs for sleeping.

(Continued on 809-C)

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene Mancinas	TELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: HERNANDEZ, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 103907919
	VISIT DATE: 08/12/2021

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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area located on the side of the house is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Pediatric CPR is to expire on 01/11/2022. Licensee completed Child Abuse Mandated Reporter Training on 01/05/2020 and is to be renewed by 01/05/2022. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiency is being cited.This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene Mancinas	TELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC809 (FAS) - (06/04)

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