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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700380
Report Date: 01/24/2022
Date Signed: 01/26/2022 09:05:23 AM

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:FERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
197700380
ADMINISTRATOR:FERNANDEZ, WELLZINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 434-3584
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:14CENSUS: 3DATE:
01/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Wellzina FernandezTIME COMPLETED:
03:00 PM
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.On 1/24/2022, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Required 1 Year inspection at the Fernandez Family Child Care. Upon arrival, the LPA met with the licensee, Wellzina Fernandez who guided the LPA on a tour of the facility. Individuals that reside in the home include 1 adult (Licensee) and 2 Minor children (age 12 and 8 ). Per LIS, facility annual fees are current. All adults living in the home have been background cleared. Per licensee, the hours of operation are Monday through Sunday 7:00 a.m. to 6:00 A.m (Except Saturday) LPA observed 3 children in care.

The Home is set up as follows:
This is a two story 5 bedroom, 3 bathrooms home with kitchen, living room, dining room, family room, office, and garage. The garage is used for storage only and no child care activities are conducted there. There is no pool, spa, or other bodies of water on the premises. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The home has central heating and air conditioning. All windows have screens and are free of cracks, bugs, and debris. Hanging window blind cords are inaccessible to children.

Ø Main Area: Main Area: Main care is provided in the Family room used as Day Care room, living room, dining room, and Bathroom #1 that is off the hallway adjacent to the family room. There is a security gate located on the staircase that prevents children from accessing upstairs.

· Living Room: There is a TV which plays educational videos for children. Also, LPA observed 2 big tables for School-age children and an adult size couch.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700380
VISIT DATE: 01/24/2022
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· Family Room: In the family room, LPA observed a fireplace that was properly screened via a mirror glass barrier which made it inaccessible to children. LPA observed age-appropriate toys and furniture for the children. A small table was observed with a total of eight chairs. Several plastic storage bins were observed in which games and toys are stored for the children. A small play kitchen was located by the door with which children can play. There are games and books on the premises of this facility. There are mats on the floor that have educational/learning activities on them. The mats were observed to be in good condition. LPA observed age-appropriate furniture and toys in the room. There are learning mats on the floor that are educational tools. LPA also observed a fish tank on the counter in the family room.

· Kitchen The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children (Safety gate). LPA observed proper storage of all cleaning detergents, medications, and sharp pointed objects. Many of the cabinets were secured by child proof latches. In the kitchen, all sharp utensils, poisons, and medications are made inaccessible to children with child safety latches on cabinet doors and drawers.

· Children Bathroom: Children use the bathroom located in the hallway adjacent to the family room. The Bathroom was toured and inspected sink/toilet is in operable condition. Toilet and faucets are clean, safe, and operable. All poison and medications are made inaccessible to children with child safety latches on the sink cabinet and drawers. The bathroom was observed to be free and clear of hazardous items. The bathroom was clean, sanitized, and in good repair.

· Backyard is accessible to children): The backyard was inspected; The outside backyard is used by the children for outside play. The backyard is gated all around. The outdoor play area was observed to be free of hazards, loose and sharp parts. There is a barbecue grill (covered) on the right side of the yard. There are grass & concrete areas for active play. There is also a covered patio.

Ø Off-limit areas of the home include the home's entire upstairs (gated), Bedroom #1 office (downstairs), Kitchen, garage, laundry room.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700380
VISIT DATE: 01/24/2022
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Ø Others:
· AC/Heating Unit was observed. AC/Heating Unit is located on the right side of the home is inaccessible.
· Napping: Children will nap in the designated nap areas with adult supervision. LPA observed 4 mats and sleeping bags in the closet.
· The First Aid kit is located in the kitchen inaccessible to children on top of the refrigerator. The First Aid Kit was observed complete with supplies and a first aid manual.
· Fire extinguisher (2A10BC): LPA observed there is a required fire extinguisher (2A10BC) fully charged Date: 12/20/21 and located in the kitchen inaccessible to children.
· Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested operable.
· Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
· Bodies of water: Per licensee, there are no bodies of water in the home.
· Medications and cleaning solutions: Detergents/cleaning compounds are in the garage (safety lock observed). Medicines are in a magnet locked kitchen cabinet.
· Weapons or Firearms: Per licensee, there are no weapons or firearms. LPA did not observe any weapons or firearms.
· Phone service: There is a working land line or cell phone
· Transportation: The licensee will transport daycare children.
· Incidental Medical Services (IMS): 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The Licensee will not be providing IMS to the children at this time.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022
LIC809 (FAS) - (06/04)
Page: 8 of 9
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700380
VISIT DATE: 01/24/2022
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Ø Documentation:

· CPR/First Aid: LPA observed licensee has current Pediatric CPR and First Aid Training with expiration date (09/2021) 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.
· Immunization: The licensee has the required immunizations. The licensee provided a written statement declining the influenza vaccination.
· Mandated Reporter Training: The licensee has completed the online mandated reporter training at www.mandatedreporterca.com, and will renew 10/11/2022
· Transportation: The licensee does provide transportation for children. The licensee has a valid California driver's license with an expiration date of 02/23/2019. Licensee has valid vehicle insurance with the expiration date of 03/04/18 and vehicle registration dated 05/18/20.
· Child files: LPA reviewed 7 children's records, the records are incomplete
· Staff File: No assistant yet
· Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 11/27/2020.

· Facility Roster: LPA observed Child Care, Facility Roster. Per Licensing Information System, facility annual fees were current.


· Licensee has posted as required the Facility License, Emergency Disaster plan, and Parents Rights Poster. The facility roster is not current. there are no current facility earthquake/fire drills documents observed during the time of this inspection.

Ø The following information was discussed with the licensee:


ü Mandatory Forms for the children’s files and provider’s files.
ü Requirements for fire drills, earthquake drills, and documentation for both.
ü The role and responsibilities of being a mandated reporter were discussed.
ü The licensee is reminded that 100% supervision is required for children at all
times.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022
LIC809 (FAS) - (06/04)
Page: 3 of 9
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700380
VISIT DATE: 01/24/2022
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ü Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
ü Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.
ü Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
ü The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

ü Criminal Record Statement: Licensee [or facility representative] 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 the 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.

ü Safe Sleep: LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.

ü Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.

ü The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022
LIC809 (FAS) - (06/04)
Page: 9 of 9
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700380
VISIT DATE: 01/24/2022
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ü --Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
n Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

ü The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.

ü A copy of the Safe Sleep Proposed Regulations was provided to Licensee.

ü LPA provided consultation during the inspection.

No deficiencies are being cited at this time, the facility complies with Title 22


An exit interview conducted and the report was reviewed with the licensee Wellzina Fernandez.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022
LIC809 (FAS) - (06/04)
Page: 2 of 9