304310373-6-7-2019-06-CC-WPOT-BCWN6F-20190607101105

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304310373
Report Date: 06/07/2019
Date Signed: 06/07/2019 10:11:19 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	RAMIREZ DE HERNANDEZ,YADHIRA		FACILITY NUMBER:	304310373
ADMINISTRATOR:	RAMIREZDEHERNANDEZ,YADHIRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 436-0995
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	14	CENSUS: 5	DATE:	06/07/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	08:26 AM
MET WITH:	Lorena Pineda, Assistant and Yadhira Ramirez De Hernandez, Licensee		TIME COMPLETED:	10:45 AM

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	An inspection was conducted at the facility by Licensing Program Analyst (LPA) Port . A review of adult records indicates that all facility residents, staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are presently 3 adults and 1 child living in the home. Upon arrival LPA met with Assistant, Lorena Pineda who was observed caring for 3 preschool age children. An infant was dropped off at the facility at 8:49 AM and an additional preschool age child was dropped off at the facility at 9:00 AM. The licensee arrived at the facility at approximately 9:05 AM. Also present not interacting with day care children was the licensee's adult son in an off limits bedroom. During today’s inspection the home and grounds were toured and the licensee was operating within the licensed capacity. Overall census observed was 1 infant and 5 preschool age children. Licensee stated operating hours are 24 hours per day, 7 days per week based on need of the parent. The licensee understands that care shall not exceed a 24 hour period for each child. The floor plan was verified. Off limits areas are made inaccessible by means of door locks and baby gates. Bedroom #1, Bedroom #2, and Bedroom #3, and both side yards as identified on the facility sketch are off limits. The children use the backyard as the outdoor play area, and it is completely fenced. The outdoor play area is free from hazards. There are no bodies of water on the premises. There is a fireplace in the living room screened by a fire place cover and inaccessible to children in care. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. LPA observed a poisonous item "wasp & hornet killer" in the backyard on top of a sprinkler box approximately 5 feet off the ground. The poisonous item was inaccessible to children in care. Regulations require poisonous items to be locked. Page 1 of 3 (Continued on Page 2)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RAMIREZ DE HERNANDEZ,YADHIRA	FACILITY NUMBER: 304310373
	VISIT DATE: 06/07/2019

NARRATIVE

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The home provides safe toys, equipment, and materials. During today’s inspection each child was observed to have safe, healthful, and comfortable accommodations, furnishings, and equipment. There is a working carbon monoxide detector, smoke detector, and fire extinguisher in the home that meet statutory and State Fire Marshall standards. The licensee has a current roster of children in care.

The facility has conducted an emergency drill within the past six months. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit.

The licensee stated she is present in the home and ensures that children that children in care are supervised at all times. The licensee stated children are not left in parked vehicles. The licensee states when temporarily absent from the home, she arranges for a substitute adult to care for and supervise children in her absence.

The licensee's and assistant's (present today) pediatric CPR/First Aid certification is current, which expires 04/08/2021. Children's records for children present during today's inspection were reviewed and in substantial compliance. Proof of immunization against influenza (or written decline) pertussis and measles for licensee and assistant present during today's inspection were reviewed and within compliance of SB 792.

Beginning March 31, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years, per A.B. 1207. The licensee is exempt from this requirement due to the training not being available in Spanish.

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 .

(Continued on Page 3)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RAMIREZ DE HERNANDEZ,YADHIRA	FACILITY NUMBER: 304310373
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/07/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/27/2019 Section Cited CCR 102417(g)(4)(A)	1 2 3 4 5 6 7	Operation of a Family Child Care Home 102417(g)(4)(A) Storage areas for poisons, firearms and other dangerous weapons shall be locked. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The licensee removed the poisonous item during LPA's inspection and placed it in a locked storage shed in the backyard. The licensee will view the child care video "Locks and Inacessibility Requirements in Childcare" from www.ccld.childcarevideos.org and send a written acknowledgment to our office by the due date of 06/27/2019.
	8 9 10 11 12 13 14	LPA observed a poisonous item "wasp & hornet killer" in the backyard on top of a sprinkler box approximately 5 feet off the ground. The poisonous item was inaccessible to children in care. Regulations require poisonous items to be locked. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RAMIREZ DE HERNANDEZ,YADHIRA	FACILITY NUMBER: 304310373
	VISIT DATE: 06/07/2019

NARRATIVE

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Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov A hard copy of the Spanish Spring 2019 Child Care Quarterly Update and the California Department of Social Services Lead Information brochure was provided to the licensee. A hard copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee in Spanish. The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

The following violation of the California Code of Regulations, Title 22; Division 12, was observed and cited today: Operation of a Family Child Care Home 102417(g)(4)(A) see LIC 809D.

Inspection, report review and exit interview was conducted in Spanish. Notice of Site Visit was posted during the visit. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

LIC809 (FAS) - (06/04)

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