197700450-10-19-2020-12-CC-NFLS-BUJUQ5-20201019154635

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700450
Report Date: 10/19/2020
Date Signed: 10/19/2020 03:47:36 PM

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 CARE		FACILITY NUMBER:	197700450
ADMINISTRATOR:	BLANCA FERNANDEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 964-7262
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	14	CENSUS: 0	DATE:	10/19/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Blanca Fernadez		TIME COMPLETED:	03:00 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	Licensing Program Analyst (LPA) Nadia Flores conducted an announced Pre-Licensing Relocation Tele-Visit Inspection. LPA spoke with Licensee, Blanca Fernandez, who guided analyst on a virtual tour of the home via FaceTime. This visit was held virtually due to COVID-19 Emergency Response. Licensee is requesting to operate a Large Family Child Care Home with the capacity of 14 children. Currently residing in the home is Licensee and 2 minor children. Days and hours of operation will be Monday through Friday 6:00 AM-6:00 PM. Licensee and LPA toured the home indoor and outdoor to ensure the home meets licensing requirements. The home is set up as follows: This a one story home with 3 bedrooms, 2.5 bathrooms, a living rooms,a den, dining room, kitchen, laundry room, backyard with two sheds and an attached garage. Per licensee the following areas of the home will be utilized for the Family Child Care: Living room and den, bathroom #1, the back yard and dining room. Living room will be the day care area along with the den which will also be utilized as an isolation room. The off-limits areas of the home includes all bedrooms, bathrooms #2 and #3, kitchen, laundry room, and attached garage. The hall way that leads to the bedrooms is made inaccessible by a safety gate. The home has central air conditioning and heat. All sharp knives are stored in a high cabinet in the kitchen, poisons are stored in the garage which is locked with a lock-and-key, and medications are stored in the master bedroom. Bathrooms were toured and inspected, sinks and toilets are in operable condition.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Nadia Flores	TELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

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: 197700450
	VISIT DATE: 10/19/2020

NARRATIVE

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LPA noticed a fireplace however is not operable and blocked to be made inaccessible with a shelf. The First Aid kit is located in the kitchen on the top of the fridge. Per Licensee, there are no weapons or firearms in the home. LPA did not observe any weapons or firearms. Smoke detectors and Carbon Monoxide are in operable condition. The Fire Extinguisher was in the green. Licensee Pediatric CPR/First Aid expires on 09/2021. Licensee had the required immunization against pertussis (TDAP) and measles (MMR). Fire clearance to operate a large family child care home was granted on 10/13/2020.

The required posted documents were posted and located in the day care room: Notification of Parent's Rights Poster (PUB394), Emergency Disaster Plan (LIC610A), and Earthquake Preparedness Checklist (LIC9148).

The following was discussed with Licensee:

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; Licensee was reminded that 100% supervision is required at all times to children in care; Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

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SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Nadia Flores	TELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

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: 197700450
	VISIT DATE: 10/19/2020

NARRATIVE

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Licensee was informed that all adults living in or having access to the home, or are employees are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Central Index prior to having contact or working with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analysis of any person who will be visiting regularly or for longer than one week. The applicant was advised to utilize the Request for Livescan Service LIC 9163 to have adults fingerprinted and associated to the home.

Licensee was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. Licensee was informed to utilize the Unusual Incident Report/Injury Report LIC 624B when submitting the report to the department.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Nadia Flores	TELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

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: 197700450
	VISIT DATE: 10/19/2020

NARRATIVE

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Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

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

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Nadia Flores	TELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

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: 197700450
	VISIT DATE: 10/19/2020

NARRATIVE

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Licensee was advised it is her responsibility to visit the department's website to access licensing forms, Quarterly Updates and Provider Information Notices (PINs): www.ccld.ca.gov

Safe Sleep Links:

AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

Before a day care license is granted the following items will need to be corrected:

-Licensee will take the mandated reporter training.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Nadia Flores	TELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

LIC809 (FAS) - (06/04)

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