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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310373
Report Date: 07/26/2023
Date Signed: 07/26/2023 12:18:57 PM


Document Has Been Signed on 07/26/2023 12:18 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:RAMIREZ DE HERNANDEZ,YADHIRAFACILITY NUMBER:
304310373
ADMINISTRATOR:RAMIREZDEHERNANDEZ,YADHIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 791-1114
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:14CENSUS: 8DATE:
07/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Yadhira Ramirez de HernandezTIME COMPLETED:
12:40 PM
NARRATIVE
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On July 26, 2023 Licensing Program Analyst (LPA) A. Silva conducted an unannounced Case Management – Incident visit assisted by licensee Yadhira Ramirez de Hernandez and assistant Dina Ruiz. Upon arrival, the licensee and assistant had a total of 4 preschool clients and 4 school age children. The facility was operating within its licensed capacity and within compliance of staff-to-child ratios. An on-site Facility Personnel Report Summary review showed that all facility residents, staff, or other individuals who require background checks have received criminal record and child abuse index clearances or exemptions. Four adults, including the licensee, currently live in the home.

PERSONNEL RECORDS: The LPA reviewed staff files. The licensee’s mandated reporter expires on 8/20/2023 and the Pediatric CPR/First Aid certification expires on 5/2025. The assistant did not have a mandated reporter in file, proof of immunization against Tdap, MMR, and influenza, and tuberculosis screening (See 809D).

CHILDRENS’ RECORDS: The licensee had a roster of clients who are provided care. The LPA reviewed the file of five clients. All files reviewed were in compliance.

The Incidental Medical Services (IMS) policy was discussed. A link to PIN 22-02-CCP was provided here: PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: RAMIREZ DE HERNANDEZ,YADHIRA
FACILITY NUMBER: 304310373
VISIT DATE: 07/26/2023
NARRATIVE
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The licensee understands that he or she shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a [qualified] substitute adult to care for and supervise the children during his/her absence [A qualified substitute adult is an adult that has criminal record and child abuse index clearances, immunizations, and current Pediatric CPR/First Aid and Mandated Reporter training]. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day, in accordance with Section 102417 of the California Code of Regulations. The licensee understands that children are not to be left alone in parked vehicles.

The licensee understands that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption prior to the initial presence in a licensed child care facility. Violation of this requirement will result in a citation of a deficiency and civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.

The licensee understands that a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year, in accordance with Section 1597.622 of the Health and Safety Code.

The licensee understands it is his or her responsibility to review the Provider Information Notices (PIN) found on the CCLD website above. If not yet registered, the licensee agrees to register to receive quarterly updates via email at childcareadvocatesprogram@dss.ca.gov or online at https://cdss.ca.gov/inforesources/community-care-licensing/subscribe

The facility was not in compliance. Violations of the California Code of Regulations, Title 22, Division 6 were observed, discussed, and cited at the time of the visit. The following violations of the CCR were cited in the attached 809D: 1596.8662 Administration of Child Day Care Licensing and 1597.622 Employees or volunteers at family day care home.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: RAMIREZ DE HERNANDEZ,YADHIRA
FACILITY NUMBER: 304310373
VISIT DATE: 07/26/2023
NARRATIVE
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The LPA conducted an exit interview and reviewed the report with the licensee. The Notice of Site Visit was posted. The licensee understands that the Notice of Site Visit shall remain posted for 30 days. The Appeal Rights were explained. The licensee received a copy of the Appeal Rights (LIC 9058 01/16), their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First-level appeals should be sent to the Regional Manager at the address listed above.
End of Report.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/26/2023 12:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 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: 07/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/28/2023
Section Cited
HSC
1597.622

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Employees or volunteers at family day care home; ... (a) (1) ... a person shall not be employed… if he or she has not been immunized against influenza, pertussis, and measles.
The licensee did not comply with the above regulation as evidenced by:
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The licensee will ask assistant to get immunization. The licensee will provide proof of correction by due date.
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Based on records review and interview, the licensee did not comply with the above regulation on one out of one assistant present, which poses a potential risk to the health or safety of clients in care. The assistant did not have proof of immunization
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Type B
08/25/2023
Section Cited
HSC1596.8662(b)(1)

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1596.8662(b)(1) Administration of Child Day Care... a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter...
The licensee did not comply with the above regulation as evidenced by:
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The assistant will complete the mandated reporter training. The licensee will provide proof of correction by the due date.
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Based on records review and interview, the licensee did not comply with the above regulation on one out of one assistant present, which poses a potential risk to the health, safety of clients in care. The assistant did not have a mandated reporter. Per licensee, assistant did not complete training.
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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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
LIC809 (FAS) - (06/04)
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