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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415181
Report Date: 08/07/2019
Date Signed: 08/07/2019 10:15:53 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:FERNANDO FAMILY CHILD CARE HOMEFACILITY NUMBER:
197415181
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
08/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Dilrukshi Fernando - LicenseeTIME COMPLETED:
10:25 AM
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On 8/7/19, Licensing Program Analyst (LPA) Helen Estrella conducted an annual/random inspection to the family child care home. Upon arrival, LPA met with the licensee and assistant. LPA confirmed with the licensee that all adults working/residing in the home have obtained a Criminal Record/TB clearance and are associated to the facility. LPA was guided on a tour of the home (inside and outside).

The home consists of 3-bedrooms, 2-bathrooms, living room, kitchen with dining area, front yard, back yard with patio and detached garage. Main care is provided in bedroom #1 and #2. The other accessible areas of the home are: bathroom #1 in children's activity room, and back yard. The off limits areas are: licensee's bedroom, bathroom #2, living room, kitchen, dining area, front yard and detached garage.

The following was observed during the inspection:

There is a fully charged fire extinguisher 2A10BC in the home, operable carbon/smoke detectors in the home. LPA observe wall heater screened to prevent access to children. Bedroom #1 and #2 have children's safety gates to prevent access to off limits areas of the home. Bedroom #2 was observed to have a bathroom and a door that leads to the back yard for outdoor activities. LPA observed bedroom #1 used for napping. There were sufficient age appropriate toys and equipment for children in care.



Outdoor area was inspected. There are age appropriate outdoor play equipment with cushioning to absorb falls. Disinfectants, toxins, chemicals and/or sharp items that pose a danger to children in care were not observed to be accessible to children during today's inspection. Licensee has current CPR/Pediatric First aid until 6/2021 and completed Mandated Reporter training completed on 6/12/18. Last fire drill conducted 1/14/19.

There were 4 children in care during the inspection. (3 out of 4 children were infants). LPA reviewed children's files and are completed with required licensing documents. LPA observed required postings on licensee's board. At this time, licensee does not provide Incidental Medical Services (IMS). Licensee states there are no weapons/firearms in the home and none observed by LPA. There are no bodies of water on the premises.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: FERNANDO FAMILY CHILD CARE HOME
FACILITY NUMBER: 197415181
VISIT DATE: 08/07/2019
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Licensee informed to conduct fire disaster drills at least once every month and log must be kept. Licensee reminded that children records and facility roster must be kept for 3 years and advised all public reports must be kept for review. Forms and Regulations available at: www.ccld.ca.gov. Licensee informed of appeal rights, must be in writing within 15 business days from date of receiving penalty assessment.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000.

Licensee informed of Unusual Incident/Injury Report and how to contact the Licensing office within 24 hours of the occurrence. A written Unusual Incident/Injury Report (LIC 624B) is to be submitted within 7 business days.

Licensee was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation. Licensee was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category.

Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.
The licensee was also recommended the following safe sleep practices:
Always place infants on their backs for sleeping; use only a tight-fitting sheet on the crib or play yard mattress; do not hang any items from the crib or above the crib; keep all items, including blankets, out of the crib or play yard; pacifiers may be used as long as they do not have items attached to them; infants should not be swaddled or have any items covering them while sleeping; the temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold. Please note, these guidelines are recommendations for best practices only, until regulations are approved and adopted.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
LIC809 (FAS) - (06/04)
Page: 3 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: FERNANDO FAMILY CHILD CARE HOME
FACILITY NUMBER: 197415181
VISIT DATE: 08/07/2019
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The licensee was advised that, once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, (Type A violation), a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.

The facility is operating within substantial compliance during today's inspection. An exit interview was conducted, and a copy of this report was given to licensee.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
LIC809 (FAS) - (06/04)
Page: 4 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: FERNANDO FAMILY CHILD CARE HOME
FACILITY NUMBER: 197415181
VISIT DATE: 08/07/2019
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Update on Incidental Medical Services: 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
Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.

The following information was consulted with the licensee:
All adults living and working in the home must be fingerprinted and cleared prior to entering the facility. The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.

Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations.

Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information: (916) 654-1541 Email Address: childcareadvocatesprogram@dss.ca.gov
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
LIC809 (FAS) - (06/04)
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