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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019934
Report Date: 09/23/2021
Date Signed: 09/23/2021 12:01:11 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 CAREFACILITY NUMBER:
198019934
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
09/23/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Maria Hernandez, LicenseeTIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPA) Denise Gibbs conducted an unannounced case management inspection to the above facility on 9/23/21 at 9:50 AM. LPA met with Maria Hernandez, Licensee, who guided analysts on a tour of the facility. The purpose of this inspection is to follow-up on a request for a capacity increase.

There were four children present upon arrival. Also present during inspection was Staff One (S1), licensee's assistant.

LPA took measurements of the gate around the in ground pool and took pictures. Measurement from the bottom of the gate to lowest top portion of the gate measures 5 feet 11 inches. The ground to the bottom of the gate measures 3.5 inches from the ground. Measurement between railings is 4 inches. LPA tested self-latch device which did not automatically close when gate was opened. Measurement from the top of the gate to the self-latching device measures 7.1 inches, which is not in accordance with Title 22. LPA did observe the pool gate to be double locked with a key via a door knob and dead bolt that are operable. Licensee is requesting a waiver to use an alarm on a window in an off limits bedroom that may provide direct access to the pool. In order to access the off limits room licensee unlocked door with a key. LPA tested the alarm on window by first unlocking the window and sliding the window open. When window opened alarm sounded until window was closed.

LPA observed the required fire extinguisher in the kitchen with purchase date 9/19/2021, as indicated on the purchase receipt. LPA observed fireplace in the off-limits kitchen screened with custom fit sliding doors and fireplace in the living room anchored with bolts and straps.

The following items need to be corrected before capacity increase is approved.
  • The self latching device on pool gate needs to be moved up so it is no more than six (6) inches from the top of the gate. ---------------------PAGE 1
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021
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: 09/23/2021
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  • Spring used on self-latching gate needs to be replaced or tightened to ensure gate self-latches automatically.



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
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021
LIC809 (FAS) - (06/04)
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