198020244-3-6-2020-54-CC-RLOZ-BMFVUU-20200306154518

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020244
Report Date: 03/06/2020
Date Signed: 03/06/2020 03:45:28 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:	FERNANDO FAMILY CHILD CARE		FACILITY NUMBER:	198020244
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	03/06/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Trevine Fernando and Shamila Fernando		TIME COMPLETED:	04:00 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	At 1:50 PM Licensing Program Analysts (LPA) Roxana Lopez conducted an unannounced Required 1 year inspection to the above facility. This inspection also serves purpose as a capacity increase inspection. Licensee's submitted the Capacity Increase request on 12/26/2019. LPA met with Trevine and Shamila Fernando, Licensees who guided analyst on a tour of the facility. Per Licensee, there are 6 children that are currently enrolled. A current children’s roster was available for review. There were 6 children present upon arrival. This is a one story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, front yard and 2 backyards divided by a fence. The children use the bathroom close to the dinning room, living room, dining room, one bedroom and 1 backyard (fenced) areas. LPA observed that there is a wall heater in the living room and is barricaded. Per Licensee, areas off limits to children and parents include: 2 bedrooms, kitchen and one bathroom. The licensee provides food for children in care. The licensee states that 3 adults and 1 child currently live in the home. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms or weapons stored in the home. 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 land- line that is used during operation hours. There is ventilation and heating (central). The following was observed and reviewed during this inspection. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. Page 1 of 4

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

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: FERNANDO FAMILY CHILD CARE	FACILITY NUMBER: 198020244
	VISIT DATE: 03/06/2020

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
26
27
28
29
30
31
32

The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary.

The valve on the required 2A10BC fire extinguisher indicates fully charged and was purchased on 5/6/2019, as indicated on the receipt. Smoke and carbon monoxide detectors were tested and are operable.

The home is observed to be clean and orderly. There are child safety gates which keeps all off limit areas inaccessible to children. There are toys available for children. Appropriate sleeping arrangements in form of mats and 2 play pens were observed.

Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided .

The licensee is observed to be operating within the license capacity limitations.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 8/2021. There are first aid supplies available.

At 2:42 PM children’s records were reviewed, including emergency information and were observed to be complete.

LPA observed that the Licensees do have proof of immunization record and the Mandated Reporter AB 1207 compliant Child Care Training Certificates are on file with the expiration date of 5/11/2021.

LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection.

Page 2 of 4

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: FERNANDO FAMILY CHILD CARE	FACILITY NUMBER: 198020244
	VISIT DATE: 03/06/2020

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
26
27
28
29
30
31
32

All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 1/28/2020.

There are no pets on the premises.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Licensee's states that they are currently caring for infants. LPA advised the licensee to sleep infants where they can always be directly supervised and advised the licensee against sleeping infants in a separate room. Licensee states that infants sleep in the living room, where they are constantly supervised.

LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA also consulted and explained Never Shake a Baby pamphlet, Lead Exposure pamphlet, Capacity Handout (Small & Large) was provided during this inspection. and Safe Sleeping practices.

Incidental Medical Services (IMS):
The licensee states that they will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

Page 3 of 4

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: FERNANDO FAMILY CHILD CARE	FACILITY NUMBER: 198020244
	VISIT DATE: 03/06/2020

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
26
27
28
29
30
31
32

LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

The request for Capacity Increase will be submitted for final review to the department. Once approved, the Licensee is required to adhere to the terms and limitations stated on the license.

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.

At 3:45 PM, exit interview was conducted with Trevine and Shamila Fernando, Licensee's including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

Page: 4 of 4