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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192011178
Report Date: 11/16/2023
Date Signed: 11/16/2023 10:34:38 AM


Document Has Been Signed on 11/16/2023 10:34 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
192011178
ADMINISTRATOR:HERNANDEZ, MARISELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 830-1032
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:14CENSUS: 6DATE:
11/16/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marisela Hernandez, LicenseeTIME COMPLETED:
11:00 AM
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On 11/16/2023 at 9:10 AM, Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required – Inspection to the above facility. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Marisela Hernandez, who guided the LPA on a tour of the facility. Adults in the home were discussed and all have criminal record clearance. Also present was S1, Licensee’s Assistant, who is cleared. There were six day care children, which includes two infants, present during today’s inspection. Licensee
states that there are currently 16 children enrolled. LPA observed required postings and disaster drill log was also available during today’s inspection, last disaster drill conducted on 09/14/2023.

This is a single-story home which consists of four bedrooms and three bathrooms, Kitchen, Living Room, and Day Care Room. Main Care Areas used by the children include the Day Care Room (located through the home in the back house that is the same address of the home) and Bathroom 3 (located inside Day Care Room). Per Licensee, areas off limits to children and parents include entire front home which includes: Kitchen, Living Room, all bedrooms, and two bathrooms. Licensee states front home is only used as a walkway to get access to Day Care Room and Living Room only used as an isolation area for sick children while they wait for parents to pick them up. LPA observed a child arrive to facility and S1 receive child at front door and escort through the home to Day Care Room. Per Licensee, off limit areas are also locked during operating hours.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed air/heat wall unit in Day Care Room. There is a working telephone maintained in the home. At 9:12 AM, LPA observed Day Care Room to have child size tables and chairs, puzzles, art materials, dramatic play area with age appropriate toys, free of loose and sharp parts, and plastic manipulatives available all well maintained at time of inspection. LPA observed couch with reading area and tall shelf filled with board games and puzzles. At 9:15 AM, LPA observed a pack-n-play and wooden crib used for infant sleep placed in Day Care Room that
Report Continues - Page 1 of 4
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023
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 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192011178
VISIT DATE: 11/16/2023
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does not inhibit walk ways or entrances/exits. LPA observed fitted sheet that fits on each individual mattress, no bumper pads, and cribs to be free of loose objects or anything hanging above at time of inspection. At 9:18 AM, LPA observed Bathroom 3 to have operable toilet and sink, adequate handwashing and toileting supplies, and to have general area safety and sanitation at time of inspection. LPA observed a wall diaper changing table in Bathroom 3 well maintained and secured on wall at time of inspection. Per Licensee, she provides food to children in care and uses Day Care Room or covered patio for eating, depending on the weather. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. LPA did not observe these items in Day Care Room at time of inspection, per Licensee these items are stored in front home. The Licensee states that there are no poisons used to kill vermin or bugs stored in the home. The Licensee does understand that poison must be locked with a key or combination lock. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the age, size, and abilities of children in care.

Per Licensee, the children will have access to backyard and covered patio for outdoor play. At 9:20 AM, LPA observed outdoor play area is accessible through door in Day Care Room. LPA observed outdoor play area has surface that is maintained for activities planned and adequate perimeter fencing through-out the yard.LPA observed covered patio area to have child size long tables with benches available for children, with a variety of age appropriate toys and materials free of loose and sharp parts. LPA observed outdoor play area to have ride along toys available, plastic play houses, a large building blocks area filled with wooden blocks available for children that was well maintained at time of inspection. LPA observed all trees, shrubs, and plants are maintained.

LPA did not observe any pets at time of inspection and Licensee confirms she has no pets. Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises or firearms/weapons at time of inspection.

At 9:22 AM, LPA observed the valve on the required 2A 10BC fire extinguisher with service tag dated 11/04/2023. LPA tested smoke and carbon monoxide detectors and observed to be in operable condition at time of inspection. LPA observed First Aid kit is kept on top of the shelf in Day Care Room. The Licensee has current Pediatric First Aid and CPR valid until 01/10/2024 and AB1207 Mandated Reporter training completed on 09/09/2023. Proof of immunization against influenza and pertussis were readily available during today’s inspection. Requirement for proof of immunization against measles were discussed.
Report Continues - Page 2 of 4
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192011178
VISIT DATE: 11/16/2023
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At 9:40 AM, LPA conducted file review of children and staff files for required documents. LPA observed S1 file to be complete. LPA reviewed 6 of 6 children's files present during today's inspection. LPA observed all children's files to be complete with required documents at time of inspection.

The following were discussed:
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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility.



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.

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.
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SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192011178
VISIT DATE: 11/16/2023
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee [or facility representative] was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Megan’s Law - Family Child Care Homes

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited only advisory given today, 11/16/2023.

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

Exit interview was conducted and report was reviewed with the Licensee, Marisela Hernandez.



Report Ends - Page 4 of 4
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5