198019934-9-10-2021-54-CC-DGIS-C6QQM7-20210910121705

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019934
Report Date: 09/10/2021
Date Signed: 09/10/2021 12:17:11 PM

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	HERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	198019934
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	09/10/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Maria Hernandez, Licensee		TIME COMPLETED:	12:30 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 Analysts (LPAs) Denise Gibbs and Lily Babcock conducted an unannounced case management inspection to the above facility on 9/10/21 at 9:45 AM. LPA's met with Maria Hernandez, Licensee, who guided analysts on a tour of the facility. The purpose of this inspection is due to licensee’s request for a capacity increase. Current license is for small family child care, licensee has requested to increase to a large family child care. Adults residing in the home have been discussed and noted. Per licensee, operation hours will be Monday to Friday 6:00AM to 7:00PM. There were two children present upon arrival. Also present during inspection was Staff One (S1), licensee's assistant. A current children’s roster was available for review. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one-story home which consists of four bedrooms, two bathrooms, living room, kitchen, detached garage, pool, front yard (not fenced) and backyard (fenced). Per Licensee, main care areas will now include the living room, front two bedrooms, two bathrooms and backyard. The children will use the bathroom located between the two main care bedrooms and a second bathroom adjacent to the backyard. Areas off limits to parents and children include two bedrooms toward the back of the home (gated), detached garage, pool, and kitchen (used as walkway to back yard only). Areas that will be used by children were inspected for safety, comfort, cleanliness. LPAs observed that there are two fireplaces, one in the living room (screened) and one in the kitchen (screened). Detergents, cleaning compounds, medications and other hazardous items that can pose a danger to children are inaccessible in a locked cabinet in the hallway. The Licensee states that there are no poisons at the facility and was advised -------------------PAGE 1

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019934
	VISIT DATE: 09/10/2021

NARRATIVE

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that poisons need to locked, not only inaccessible. The valve on the 2A10BC fire extinguisher indicates fully charged, as indicator is in the green. Licensee was advised to tape the purchase receipt to the fire extinguisher for purchase date confirmation. Smoke and carbon monoxide detectors were tested and are operable.

There are toys available for children indoors and outdoors. All required postings were observed. Children nap on cots in the main care area.

Infant Care: Currently licensee does care for infants 18 months to 24 months. Licensee does not care for children under 12 months old. There were no infants in care during todays visit. LPAs observed two cribs visible and free of hazards. LPA's discussed new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15 minute check documentation for infants 0-24 months, and provided PIN 20-24-CCP.

The children will use the back yard for outdoor play. Back yard observed to be fenced. LPAs observed an in-ground swimming pool in the rear of the back yard. There is a metal fence with a key lock that prevents access to the pool. The fence is in good repair and is installed so children cannot not remove any portion of it. The fence is over five feet tall and the openings between the railings do not exceed four inches. The door accessing the pool swings away from the pool and has a metal spring to retract/close the door when opened. LPsA observed that there are two dogs at the facility kept in off limit areas during business hours. The Licensee states that there are no firearms or weapons stored at the facility.

Children’s records were reviewed. Licensee was advised to check all enrollment forms for parent signature. Licensee currently has one assistant. Licensee and assistants have completed required Pediatric First Aid and CPR and Mandated Reporter training which are current. Licensee and assistant also have required immunization's. There are first aid supplies available.

Incidental Medical Services (IMS):

IMS was discussed. – IMS. administrative records. 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.
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SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019934
	VISIT DATE: 09/10/2021

NARRATIVE

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Licensee is seeking to provide care for 14 children Zero - school age. A fire clearance has been granted as of 8/2021. Based on today’s observation a capacity increase will be granted upon Licensing Program Manager (LPM) Approval.
At this time, the facility is in compliance with California Title 22 Regulations. Therefore, there are no deficiencies being issued today.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Maria Hernandez, Licensee, including, but not limited to Appeal Procedures and Appeal Right.

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SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

LIC809 (FAS) - (06/04)

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