197493660-7-13-2022-30-CC-SORS-CGAV6S-20220713161001

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493660
Report Date: 07/13/2022
Date Signed: 07/13/2022 04:10:09 PM

Document Has Been Signed on 07/13/2022 04:10 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	FERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	197493660
ADMINISTRATOR:	LESLIE FERNANDEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 886-0905
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	14	CENSUS: 11	DATE:	07/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	LESLIE FERNANDEZ - Licensee		TIME COMPLETED:	04:15 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 07/13/2022 Licensing Program Analyst (LPA), Suzette Ornelas conducted an unannounced Annual Required Inspection and was met by Licensee LESLIE FERNANDEZ. Also present were Staff #1 (S1). Days and hours of operation are Monday through Friday 6:30a to 6p. LPA toured the home inside and outside and a census was taken. LPA observed 11 children. Current facility sketch reviewed and Licensee confirmed that the day care room, living room, dining room and the bathroom located in the hallway to the right are on limits and are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of closed doors and supervision. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The First Aid kit was observed and complete. Per LIS the facility annual fees are current. The facility roster was observed, and current. There are age appropriate toys and napping equipment on the premises. The required fire extinguisher (2A 10BC), carbon monoxide detectors and smoke detectors are in operable condition. Licensee has posted as required the License, and all other required postings in a visible location. Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. LPA observed there was a pool on the premises. The pool was fenced with at least five feet high fence. The fence does not obscure the pool from view. The gate swings away from the pool self-close and have a self-latching device located no more than six inches from the top of the gate which remains locked at all times. The fireplace located in the living room is made inaccessible by a glass screen and will not be in use during daycare hours. There are no stairs in this home.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197493660
	VISIT DATE: 07/13/2022

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There are currently 3 infants in care. LPA discussed Infant Safe Sleep Regulations with licensee. LPA provided licensee with a copy the regulation, a sample of an infant safe sleep log, and a copy of the LIC 9227. Licensee will immediately begin documentation of Infant Safe Sleep for all infants in care as well as the LIC9227 for 1 infant under 12 months and provide proof via email to LPA. Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained. LPA reviewed 10 children's records and observed records were incomplete. Licensee will provide proof of 2 immunization records, LIC 995 and LIC627 to LPA via email.

An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee and all other employees have not completed the Mandated Reporter Training. LPA provided licensee with a copy of the regulation. Licensee will submit proof of completion via email to LPA. Licensee’s pediatric CPR/First Aid expires on 04/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022

LIC809 (FAS) - (06/04)

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