198004326-8-13-2019-33-CC-CRES-BEZPRD-20190813113233

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198004326
Report Date: 08/13/2019
Date Signed: 08/13/2019 11:32:42 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	HERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	198004326
ADMINISTRATOR:	HERNANDEZ, NORMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 919-7199
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91790
CAPACITY:	14	CENSUS: 6	DATE:	08/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Norma Hernandez		TIME COMPLETED:	11:40 AM

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	ANNUAL RANDOM INSPECTION CONDUCTED IN ENGLISH An Annual Random Inspection was conducted by Cynthia Reyes and Alicia Mooberry, Licensing Program Analyst (LPA). Met with licensee, who guided the analyst on a tour of the facility on this date. Also present was Licensee's daughter Diana Hernandez. This is a single story home. Residing in facility are 3 Adults and 0 Children. The home was inspected 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. Day Care days and hours are: M-F 7am-5:30pm. Areas used by the children were inspected as follows: Family room, Day-care room with bathroom, back yard. Areas off limits include: Front yard, garage, kitchen, small and large dining rooms, living room, washroom, 3 bedrooms and 1 bathroom. Rooms that are off-limits need to be made inaccessible during operating hours *The Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.* There are NO weapons, firearms. There is a pool in the yard. There is mesh fencing at least 5 feet high , It is placed in front of the bedroom windows facing into the pool area to prevent entry into the pool area. The rest of the yard has a 5 foot tall wrought iron fence that is gated to keep children out of the pool area. Gate opens away from the pool and self latches when closed. Gate door is kept locked and key to lock hangs on pole inside pool area reachable only by adults. There are no openings between the vertical bars or between the bottom horizontal bar and the cement that is more than 4 inches wide. Measurements were retaken on this date. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors, carbon monoxide and fire extinguisher (2A 10BC) are in operable condition.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198004326
	VISIT DATE: 08/13/2019

NARRATIVE

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Child Care Roster, Disaster Plan, Emergency Disaster Drill and Children's Records were reviewed.
Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement.

The following was discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to licensure. Individuals within one month of their 18th birthday must be fingerprinted immediately. The existing, immediate $100 per individual Civil Penalty has been increased to an immediate $100 per day Civil Penalty, for a maximum of five days for the first violation and a maximum of 30 days for subsequent violations. If an individual has a clearance with the Department a criminal record clearance may be transferred. LIC 9182 Criminal Background Clearance Transfer Request may be used. No smoking, No infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category, earthquake – fire, disaster drills and safety, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal records, child abuse clearance and criminal records transfer requirements, SIDS, Never Shake A Baby flyers given and discussed, Incidental Medical Services (IMS) was discussed.

Licensee has been advised of the following:
· Pools should be inaccessible by a pool cover or a 5-foot fence around the perimeter of the pool. If the fence is made from chain link, the opening should not allow a golf ball to pass through. Fences made from mesh will need to be approved by the department. Mesh fence will remain in place whenever licensed care is provided, and as long as the mesh fence makes the swimming pool inaccessible to children as determined by licensing staff- Licensee’s initials ( ).
· Pool cover label should read F1346-91 American Society for Testing Material and it should be able to withstand the weight of an adult without water above cover when standing.
· Dog(s) and or pets should be isolated from children in care.
· It is recommended that a First Aid kit be available on premises.
--100% Outdoor supervision is always required. If outdoor area not adequately fenced provider must always be with children when outdoors. Licensee's Initials( ).

Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l

INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198004326
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/13/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/23/2019 Section Cited HSC 1597.66(a1)	1 2 3 4 5 6 7	Employees or volunteers at family day care home; immunization requirements; records; exemptions Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis and measles. Each employee	1 2 3 4 5 6 7	Licensee states she will obtain copies of all the required immunization records or send a declaration that they are no longer part of her day care staff and send by the POC date,
	8 9 10 11 12 13 14	Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The requirement is not met as evidence that the Licensee could not provide proof of any immunization for staff. This is a potential risk to the health and safety of children in care	8 9 10 11 12 13 14
Type B 08/23/2019 Section Cited HSC 1596.8662(4)(b)(1)	1 2 3 4 5 6 7	Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter on or before March 30, every two years following 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training	1 2 3 4 5 6 7	Licensee states she will have all her staff take the mandated reporting training and send a copy of the certificate by the POC date.
	8 9 10 11 12 13 14	and shall complete renewal mandated reporter training the date on which he or she completed the initial mandated reporter training and submit proof of completion. The requirement is not met as evidenced by all staff has not completed the mandated reporter training. This is a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198004326
	VISIT DATE: 08/13/2019

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****Licensee advised that signing the report does not imply agreement with the findings but is acknowledging receipt of the licensing report.****

The following deficiency's are cited in accordance with Title 22 of California Code of Regulations and discussed with licensee: See 809 D attached and consultation was conducted on this date.

An exit interview conducted with licensee, appeal rights, progressive civil penalties were explained including a copy of this report was given to the licensee and LIC 9213—Notice of Site Visit was posted during this visit. Notice of Site Visit must be posted for 30 days. Failure to post required visit reports for 30 consecutive days will result in immediate civil penalty assessment of $100

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

Health & Safety Code 1597.622(a1) Employees or volunteers at family day care home; immunization requirements; records; exemptions Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter on or before March 30, every two years following 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training the date on which he or she completed the initial mandated reporter training and submit proof of completion.
AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

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