304312340-12-3-2020-06-CC-KDEI-BVXSDP-20201203124727

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304312340
Report Date: 12/03/2020
Date Signed: 12/03/2020 12:47:51 PM

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:	HERNANDEZ, ESMERALDA		FACILITY NUMBER:	304312340
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	12/03/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Licensee Hernandez, Esmeralda		TIME COMPLETED:	01:00 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	Licensing Program Analyst (LPA) Ketki Desai conducted an unannounced In-person Case Management License initiated inspection for a change in capacity at the existing Family Child Care home. LPA met with Licensee Ms. Hernandez, Esmeralda who gave a tour of the home. At the time of inspection there were 1 infants and 3 toddlers in care. A review of the Facility Personnel Report Summary dated (12/3/20) indicates all adults, residing in the home who require caregiver background check clearances are cleared Licensee is requesting a Large family childcare home license. Per Licensee, operation hours will be Monday to Saturday, 6:00AM to 5:00AM. Licensee states that she will care for children Infants to 12 years old children. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single-story home with 4 bedrooms, and 2 restrooms. Licensee stated all bedrooms, master bathroom, garage, second living room adjacent to the kitchen, and kitchen are off-limits. Off limits areas are made inaccessible by means of baby gates, door knobs and door locks. The accessible childcare areas are family room, and bathroom down the hallway next to bedrooms. Licensee stated she is not currently registered with any Foster Care agency or holds a foster parent license, she was informed if any changes are to occur, Department shall be notified. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. The home has a center Air /Heating system, the A/C unit is installed in the backyard with an installed fenced barrier around it. There is a fireplace in the off limit area and it has been covered with wooden TV cabinet is placed in front serving as a safe barrier. (Page 1)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2020

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 6

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: HERNANDEZ, ESMERALDA	FACILITY NUMBER: 304312340
	VISIT DATE: 12/03/2020

NARRATIVE

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Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The licensee states (that there are no poisons on the premises). Licensee was advised that any poisons must be locked with a key or combination lock.

Based on the Facility Sketch submitted, areas off limits to children and parents are: All four bedrooms, master bathroom, garage, second living room adjacent to the kitchen, and kitchen are off-limits. Front yard of the home is listed as off limit area and is used only as an entrance to the home. Off limits areas are made inaccessible by means of baby gates, door knobs and door locks. Kitchen is off limits and a child safety gate has been installed across the dining room making the kitchen area inaccessible to children. Licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary.
LPA also observed COVID19, precautions at the facility, with required postings, temperature checks upon arrival, social distancing and activities being held in small groups.

OUTDOOR PLAY AREA: Backyard is designated for outdoor play area, it is fenced and has concrete flooring, as well as the grassy area. Child use the shared area with concrete flooring. It has a child safety barrier which is moveable and Licensee has placed several safe outdoor toys for the children.The outdoor play area is free from hazards.

Per applicant, there are no pets, firearms, weapons or bodies of water on the premises.

The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable.

There are toys available for children. Mats are used during napping time, linens and blankets are provided by the parents. Young infants use cribs and playpens. LPA also observed a changing table for infant care.

All the items needed for Infant care (Diapers/ Wipes/ Creams/ lotions/ Food/ Formula shall be provided by the parents, the items shall be stored and labelled with name and date.

(2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2020

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: HERNANDEZ, ESMERALDA	FACILITY NUMBER: 304312340
	VISIT DATE: 12/03/2020

NARRATIVE

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Licensee states that she does provide Break/ Lunch and snacks for children in care and is enrolled in the Food Program. If Food brought from the children’s homes, those containers are labeled with child’s name and properly stored or refrigerated.

Licensee is current on the Pediatric First Aid and CPR which expires 8/8/2022. There are first aid supplies available.

Licensee. Infants nap in crib, Licensee was made aware of Infant care and PIN 20-24CCP was also discussed with the Licensee

Licensee has a cell phone that is used for childcare. Licensee was informed if a cell phone is used for childcare, it must always remain on the premises during hours of operation.

The following was discussed with the applicant:
·Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately.
Civil Penalties will be assessed if not in compliance.
·In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license.

·Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
·The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
Applicant was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov.

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home. Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.Fire and safety drills must be performed every six months and documented for review by the Department. (3)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2020

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: HERNANDEZ, ESMERALDA	FACILITY NUMBER: 304312340
	VISIT DATE: 12/03/2020

NARRATIVE

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Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

UPDATE: H&S 1597.622: Commencing September 1, 2016, 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.
The licensee has submitted proof of immunization"s.

UPDATE: Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

Licensee provides Infant care and following was reviewed and new PIN released in September was shared.

A copy of “A Child Care Providers Guild to Safe Sleep” was provided to Licensee:

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

(4)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2020

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: HERNANDEZ, ESMERALDA	FACILITY NUMBER: 304312340
	VISIT DATE: 12/03/2020

NARRATIVE

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LPA reviewed with applicant the following safe sleep best practices:
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

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

OTHER INFORMATION AND FORMS PROVIDED: (Posters were emailed to the Licensee)
 Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.

Fire inspection services (OCFA) have granted the fire clearance and is on file.

The licensee does have a current roster of children in care.

The facility was in compliance for a (Large Family Child Care Home) with Title 22 Regulations at the time of inspection. A license will be issued after final review, in the event additional requirements are needed, the applicant will be notified.

(5)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2020

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: HERNANDEZ, ESMERALDA	FACILITY NUMBER: 304312340
	VISIT DATE: 12/03/2020

NARRATIVE

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On today’s inspection each child was observed to have a safe, healthful and comfortable accommodation furnishing and equipment’s.

An exit interview conducted with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and 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 to the address listed above.

The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

(end of report)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2020

LIC809 (FAS) - (06/04)

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