192007796-11-1-2022-12-CC-AVIA-CKRRQL-20221101131342

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192007796
Report Date: 11/01/2022
Date Signed: 11/01/2022 01:13:53 PM

Document Has Been Signed on 11/01/2022 01:13 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	HERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	192007796
ADMINISTRATOR:	HERNANDEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 765-1418
CITY:	SUN VALLEY	STATE: CA	ZIP CODE:	91352
CAPACITY:	14	CENSUS: 5	DATE:	11/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Maria Hernandez, Licensee		TIME COMPLETED:	01:40 PM

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 11/1/2022 Licensing Program Analysts (LPAs) Beneroso and Villa, met with licensee, Maria Hernandez who guided analyst on a tour of the facility for the One Year Required inspection. Upon arrival LPAs observed 5 children in care and 3 adults caring for them. Family members residing in the home include licensee, licensee’s husband, one adult daughter. Facility hours of operation are Monday - Friday 6AM- 6 PM. Incidental Medical Services (IMS) policy was discussed. Per licensee, daycare is provided primarily in the back family room, and accessible areas of the home are one bedroom, one bathroom, kitchen, living room, family room, barbecue area, and detached garage. Laundry room and garage are also off limits and are kept locked during business hours. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children. LPAs observed age appropriate safe toys and napping equipment on the premises. Per licensee children nap in the day care room on cots. Telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds which are kept in a locked upper cabinet in the hallway with appropriate safety latches, medicines are kept in a locked upper kitchen cabinet and hazardous items (sharp knives are kept in the kitchen in the upper cabinet.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise Villa	TELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 192007796
	VISIT DATE: 11/01/2022

NARRATIVE

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Safe and age appropriate toys, play equipment and materials were observed. The smoke detector, carbon monoxide detector and Fire Extinguisher (2A10BC) are all in operable condition. Electrical outlets are inaccessible, there is a designated area for ill children as necessary in the family room. Per Licensee, there are no weapon/firearms in the home. The facility sketch is complete and current, there is working land line and cell phone. Fire/Disaster drills are maintained current. Last fire/disaster drills was completed on 10/27/2022.

Bathroom: LPAs observed toilet and faucet are clean and operable. No shampoos or other cleaning products were stored in the shower or cabinets.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are located under the kitchen sink with an operational safety latch which is locked during business hours. Breakfast, lunch, and snacks are provided. Licensee stated she currently is a participant in a food program. Naps are provided on cots the family room (child care area)

Outdoor: The front yard is off limits. The backyard is completely fenced in with a brick wall. The backyard is used for outside play. The backyard is gated all around. The outdoor play area was inspected and was observed to be free of hazards, loose and sharp parts. LPA observed backyard including a padded area with a jungle gym and appropriate safe toys. There are 4 locked small storage sheds housing toys and other outdoor play equipment. There is a working sink for handwashing. The parent pickup area is located outdoors on the left side of the home and is fenced off with doors leading to the front. Licensee posts parent information and has small cubbies for each child. There are no pets on the premises.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise Villa	TELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 192007796
	VISIT DATE: 11/01/2022

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Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 7/2023. Mandated Reporter expires on 02/14/24. LPAs reminded licensee, mandated reporter training must be completed every 2 years.

Documents Provided and or Discussed: Fire Drill Log, Postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does have child care insurance.

Licensee Hernandez 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.

LPAs discussed the safe sleep regulations with licensee Hernandez and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs 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.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Hernandez along with her appeal rights.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise Villa	TELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

LIC809 (FAS) - (06/04)

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