198017321-5-16-2023-54-CC-DGIS-CRVU88-20230516152108

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017321
Report Date: 05/16/2023
Date Signed: 05/16/2023 03:21:19 PM

Document Has Been Signed on 05/16/2023 03:21 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	HERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	198017321
ADMINISTRATOR:	HERNANDEZ, NARDALINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 583-5906
CITY:	HUNTINGTON PARK	STATE: CA	ZIP CODE:	90255
CAPACITY:	14	CENSUS: 9	DATE:	05/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Nardalina Hernandez, Licensee		TIME COMPLETED:	03:30 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) Denise Gibbs conducted an unannounced annual required inspection at the above facility on 5/16/23 at 9:45AM. LPA met with Nardalina Hernandez, Licensee who guided analysts on a tour of the facility. There was one daycare child and two adults present when LPA arrived. All adults present in the home have obtained a criminal record clearance or exemption. Facility capacity is in compliance for a large Family Child Care Home. Hours of operation are Monday- Friday 6:30AM- 5:30PM. This is a one story home which consists of three Bedrooms, two Bathroom, Kitchen, Living Room, Dining Room, Den, detached garage, covered patio, back yard (fenced), front yard (not fenced). Main care is provide in the den, patio and back yard. Children have access to the living room, dining room, and one bedroom for napping infant. Off Limit Areas include: Two Bedrooms, one bathroom, kitchen & detached garage. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation located on a board in the covered patio and in the den, which included facility License, Publication (PUB) 394- Notification of Parent Rights, Licensing Form (LIC) 9148- Earthquake Preparedness form, and LIC 610- Facility Disaster Plan. All documents were observed. Facility records were reviewed for LIC 9040- Facility Roster and Disaster drill log. Last drill conducted on 4/25/23. All documents were observed. Smoke and carbon monoxide detectors, located in the in the kitchen and den were not tested today due to napping children. Fire extinguisher indicated fully charged and was serviced, 8/2022. The home maintains telephone service via operable cell phone. ----------------PAGE 1

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198017321
	VISIT DATE: 05/16/2023

NARRATIVE

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There are toys and other age appropriate material available for children in the den, covered patio and backyard. LPA observed a menu, activity plan and daily schedule in the den. The covered patio has tables and chairs where children were observed to be eating lunch upon LPA arrival. Some cleaning supplies were observed to be stored in the kitchen under the sink with a child lock. During inspection LPA observed a bedroom with an open door adjacent to the living room with a play yard that can be viewed from the main care area. Per licensee that area is is off limits to older children, one play yard remains in that room for one infant in care. LPA observed Orajel, perfumes and nail polish, accessible to older mobile children. The infant sleeping in that room is Non mobile. LPA advised the licensee to add a child safety gate so mobile children do not have access to the room or remove all items that say keep out of reach of children. LPA observed a second bedroom with an open door with a changing table visible from the hallway. Per licensee this area is off limits to older children, it is only used to change infants. LPA observed cleaning supplies in a cabinet with a sliding door under the changing table, accessible to children who walk in in the room. LPA advised licensee to Block assess to that room or remove all hazardous items. All items hazardous items were removed during inspection. LPA Isolation area for sick children waiting to be picked up is in the living room, away from the other children. Home has central air and heat. Food is provided by Licensee. Per Licensee, there are no firearms or weapons stored in the home. Children nap in the den, living room and a part of the dining room. LPA observed older children napping on mats with sheets and blankets provided by licensee.

The bathroom that children use is located off the hallway between the living room and the den. Bathroom was observed to be clean. LPA observed that one of the child locks under the sink where the cleaning products are stored does not stay latched. Items were removed during inspection until lock is relaced.

Infant Care: Currently licensee cares for three infant. LPA observed three play yards, two visible in the dining room and one in the nap room. Napping equipment does not block entrances or exits. Play yards were observed to have standard flat matt with tightly fitted sheets. LPA did not observe loose object, bumpers, objects hanging, or objects attached to the play yard. Per licensee wet or soiled sheets are changed and washed weekly. LPA observed one younger infant with a pacifier while napping. No objects were connected to the pacifier. LPA discussed Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months and 15-minute sleep check documentation for infants 0-24 months. Licensee states the following a sleep supervision plan for infants: Infant naps in the main care area where they can be supervised at all times. -----------------PAGE 2

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198017321
	VISIT DATE: 05/16/2023

NARRATIVE

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Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be gated. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. Children to do not have access to the entrance of detached garage. There are no pools or spas, or other bodies of water.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). All documents were complete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508- Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

During inspection children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

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 publication: Commonly Asked Questions about Child Care Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on LPA observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety. -------------PAGE 3

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198017321
	VISIT DATE: 05/16/2023

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee 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 initial presence in a licensed Family Child Care Home. A civil penalty of $100.00

LPA discussed the safe sleep regulations with licensee 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 additional resource. LPA also informed licensee 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Nardalina Hernandez.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 05/16/2023 03:21 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198017321
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. LPA observed one room accessible to children contained Orajel, perfumes and nail polish, one room accessible to children contained disinfectant spray under the changing table, and the bathroom accessible to children had a broken child lock making cleaning products accessible. All children were outdoors during inspection and items were removed before children entered the home, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/31/2023
	Plan of Correction
1 2 3 4	Licensee removed all hazardous items during inspection. She order child locks from Amazon to replace lock in the bathroom. Licensee will make the room with the changing table inaccessible. The nap room will contain only a bed (not used by children), the play yard and the changing table will be moved to this room. Licensee will email a picture of nap room and new lock in bathroom by POC date 5/31/23

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day 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 every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in One out of two files, mandated reporter training was observed to be expired for licensee, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/16/2023
	Plan of Correction
1 2 3 4	Per licensee, she will take the training with the time period and email LPA a copy of the certificate by POC date 6/16/23.

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: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC809 (FAS) - (06/04)

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