198018148-1-14-2025-54-CC-RDEO-DCWURH-20250114144847

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198018148
Report Date: 01/14/2025
Date Signed: 01/14/2025 02:49:03 PM

Document Has Been Signed on 01/14/2025 02:49 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	HERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	198018148
ADMINISTRATOR/ DIRECTOR:	HERNANDEZ, KARINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 674-7432
CITY:	HAWAIIAN GARDENS	STATE: CA	ZIP CODE:	90716
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 3	CENSUS: 0	DATE:	01/14/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:45 PM
MET WITH:	Licensee - Karina Hernandez		TIME VISIT/ INSPECTION COMPLETED:	03:15 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	Licensing Program Analyst (LPA) R. Derraco conducted an unannounced annual inspection to the above facility on 01/14/25. LPA arrived at the facility at 12:45PM and met with licensee, Karina Hernandez, who guided analyst on a tour of the facility. Per Licensee, there are 3 children that are currently enrolled. There were no children present upon arrival. This is a one-story home which consists of 2 bedrooms, 2 bathrooms, kitchen/dining room, living rooms, a detached garage, front yard (fenced). The off limit areas include 2 bedrooms and 1 bathroom, kitchen, and dining area. The main care area is located in the living room. LPA observed age appropriate toys, a couch, a wall mounted television, a chicco play pen, children's reading material and a wooden shelf for personal items. LPA observed a wall heater to have a wall mounted barricade making it inaccessible. The bathroom was observed with an operable sink, faucet and toilet. A tension gate was observed at the entrance of the dining area making it inaccessible to children in care. Cleaning supplies was observed to be kept in the off limits kitchen area. A space in the front yard was observed with outdoor play equipment, and perimeter fencing. During the inspection, LPA observed a child run into the outdoor play yard. LPA also observed an adult come out of the attached home and take the child indoors. Licensee knocked on front door however no one answered the door. Licensee states that tenants that live there are associated to the facility however she does not know who the child and the woman are. Licensee states that they maybe visitors. Licensee also states that the landlord is her father in-law. individuals who reside in the home have been noted and discussed. Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198018148
	VISIT DATE: 01/14/2025

NARRATIVE

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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 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety,
comfort, and cleanliness. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. LPA observed that the home is equipped with a wall mounted air conditioning unit. Heat is provided by a wall heater. The licensee understands that storage areas for poisons must be locked not just inaccessible.. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 11/14/24, as indicated on receipt. Smoke and carbon monoxide detectors were tested and are operable. LPA did not observe any objects that can pose a danger to children in care. No bodies of water were observed in the back yard play area. LPA observed pet birds caged at the front door. Licensee states that there are no firearms stored in the home. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

The licensee has not completed training on Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expired on 11/03/24. LPA advised licensee that a citation under California Code of Regualtion (CCR) Section 102416(c) will be issued. LPA observed that the Licensee does not have proof of Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. LPA advised licensee that a citation under California Health and Safety Code section 1596.8662(b)(1) will be issued. A current children’s roster was available for review.

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 an additional resource. LPA also informed licensee [or 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Exit interview conducted and report was reviewed with licensee, Karina Hernandez.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/14/2025 02:49 PM - It Cannot Be Edited

Created By: Randy Derraco On 01/14/2025 at 02:31 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198018148
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 observation, interview and record review, licensee did not renew mandated reporter AB1207 compliant training every two years which poses a potential health, safety and/or personal rights risk to persons in care.
	POC Due Date: 01/23/2025
	Plan of Correction
1 2 3 4	Licensee states she will email LPA a copy of completed mandated reporter training my POC date

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and records review, licensee did no renew her pediatric or CPR training which poses a potential health, safety and/or personal rights risk to persons in care.
	POC Due Date: 01/14/2025
	Plan of Correction
1 2 3 4	Licensee states she will email LPA a copy of cpr and pediatric first aid training certificate by POC date.

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:

Denise Gibbs

LICENSING EVALUATOR NAME:

Randy Derraco

LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198018148
	VISIT DATE: 01/14/2025

NARRATIVE

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ncidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

The following deficiencies listed on the attached LIC 809 (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.

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

Exit interview conducted and report was reviewed with licensee, Karina Hernandez.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025

LIC809 (FAS) - (06/04)

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