197408197-8-19-2022-12-CC-JTAO-CHFS7E-20220819133725

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197408197
Report Date: 08/19/2022
Date Signed: 08/19/2022 01:37:36 PM

Document Has Been Signed on 08/19/2022 01:37 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	HERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	197408197
ADMINISTRATOR:	CELIA & MARISELA HERNANDEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 837-5926
CITY:	SAN FERNANDO	STATE: CA	ZIP CODE:	91340
CAPACITY:	14	CENSUS: 3	DATE:	08/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Celia and Marisela Hernandez, Licensee's		TIME COMPLETED:	01:50 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 08/19/22 Licensing Program Analysts(LPAs) Justeene Tamayo and Andrew Alemoh met with Licensee, Marisela Hernandez who guided analyst on a tour of the facility for the One Year Required inspection. This is a one story, 2 bedroom, 2 bathroom home with kitchen/dining, children play room, living room, laundry room and garage. There is no pool/spa or body of water on the premises. Upon arrival LPAs observed 2 preschool children and 1 infant in care. Family members residing in the home include 3 adults (Licensee, co-licensee, and licensee's husband) and no children. Facility operation are Monday-Friday 6:00AM-5PM. Incidental Medical Services (IMS) policy was discussed. Physical Plant: Main care is provided in the children play room. Children use the bathroom in hallway on the right. Children have access to the dining area, and children's play room. Off limit areas include all bedrooms, bathrooms #2, laundry room (located in the garage), and garage (has a key lock door knob). The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (in garage with key lock), medicines (in upper kitchen cabinet inaccessible to children ) and hazardous items (sharp knives in kitchen drawer with magnet lock) that can pose a danger to children. LPAs did not observe a fireplace in the home. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector, Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in the children play room. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell and land line).

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene Tamayo	TELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197408197
	VISIT DATE: 08/19/2022

NARRATIVE

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Fire/disaster drill is complete and maintained current. Last fire/disaster drill was completed on 7/21/22.

Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPAs did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in garage (off limit). Breakfast, lunch, snacks and dinner are provided. Naps are provided on cots in the children's play room.

Outdoor: The backyard is safe for children. The backyard is completely fenced (with block cement). There is no body of water. LPAs observed the outdoor air conditioner to be fully barricaded with a table outside. LPAs observed age appropriate toys. Per licensee, there are currently no pets on the premises. There is a outdoor tool shed with key lock made inaccessible to children in care. LPAs also observed the barbecue pit to be fully covered.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 03/10/2023. Mandated Reporter expires 03/27/2024. There are no window cords accessible to children.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene Tamayo	TELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197408197
	VISIT DATE: 08/19/2022

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Documents Provided and or Discussed: Roster, Postings, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). LPAs provided and discussed Safe Sleep PIN 20-24-CCP and the Individual Sleeping Plan (LIC9227) with licensee. Licensee stated currently has 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 webpage 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 licensee Maricela Hernandez along with her appeal rights.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene Tamayo	TELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

LIC809 (FAS) - (06/04)

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