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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191607214
Report Date: 03/07/2023
Date Signed: 03/08/2023 05:05:03 PM


Document Has Been Signed on 03/08/2023 05:05 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
191607214
ADMINISTRATOR:HERNANDEZ, ALICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 999-6103
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY:14CENSUS: 2DATE:
03/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Alicia Hernandez, LicenseeTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Dayna Chambers conducted an unannounced annual inspection to the above facility on March 7, 2023. LPA arrived at the facility at 8:20AM and met with Alicia Hernandez, Licensee who guided analyst on a tour of the facility. Per Licensee, operation hours are Monday through Friday 6:00am to 6:00pm. There are 6 children that are currently enrolled. A current children’s roster was available for review. There were 2 children present upon arrival. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, laundry room, detached garage, front yard and backyard (fenced). The children use the bathroom in the activity room in Bedroom #1 located through the kitchen. LPA observed that there is decorative (fake) fireplace in the living room which is off-limits. Per Licensee, areas off limits to children and parents include: 2 bedrooms located through the living room area which is off-limits to children in care. The licensee provides food for children in care.
Individuals who reside in the home were noted and discussed. Per Licensee, they currently do not have an active qualified assistant. The licensee only has 6 children enrolled. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed childcare home. Licensee states that there are no firearms stored in the home. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via cellphone that is used, and the cellphone stays at the facility during operation hours. There is ventilation and heating central heat/air. Safe toys play equipment and materials were observed. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 01/08/2023, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable. Licensee states that she does not enroll infants 0-2 years in the daycare and is not caring for infants. Currently, children use the back yard and front yard for outdoor play time. The outdoor play areas were observed to be fenced. LPA observed that the outdoor yards
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna ChambersTELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 191607214
VISIT DATE: 03/07/2023
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have toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee is observed to be operating within the license capacity limitations. Licensee does not provide transportation. The licensee has completed training on with Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 12/17/2024. There are first aid supplies available. LPA advised that if a child shows signs of illness, he/she/they shall be separated from other children. Children’s records were reviewed, including emergency information and were observed to be complete. The licensee does have proof of immunizations: TDAP, MMR, declination of influenza and TB clearance. LPA observed that the Licensee does not have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 02/21/2023. There are no pets on the premises.
LPA did not observe any pools, spas, hot tubs, fishponds, or similar bodies of water during the inspection.
Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.
LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family childcare facility.
Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
LPA consulted and explained about Infant Safe Sleeping practices, but licensee does not enroll ages 0-2 years.
Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. 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. 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.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna ChambersTELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 191607214
VISIT DATE: 03/07/2023
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https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] 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.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.


A notice of site visit was given and must remain posted for 30 days.



Exit interview conducted and report was reviewed with the licensee Alicia Hernandez.

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.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna ChambersTELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 03/08/2023 05:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 191607214

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, licensee did not have a mandated reporter certificate, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2023
Plan of Correction
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Licensee will take the mandated reporter test by March 13, 2023 and email LPA a copy of the completed certificate.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna ChambersTELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4