330929355-6-3-2019-09-CC-ANOE-BCT22M-20190603170059

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 330929355
Report Date: 06/03/2019
Date Signed: 06/03/2019 05:01:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	HERNANDEZ FAMILY DAY CARE		FACILITY NUMBER:	330929355
ADMINISTRATOR:	HERNANDEZ, E		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 398-0358
CITY:	THERMAL	STATE: CA	ZIP CODE:	92274
CAPACITY:	14	CENSUS: 12	DATE:	06/03/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:53 PM
MET WITH:	Elizabeth Hernandez		TIME COMPLETED:	05:15 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	(1) On date and time listed, Licensing Program Analyst (LPA) Ana Noble arrived at the facility to conduct an annual inspection. LPA toured the facility, inside and out, records were reviewed and the following was observed and/or discussed: Upon arrival 12 children were present alone with Licensee's Assistant, and were getting up from nap time. Licensee not present. Normal days and hours of operation are: Monday through Saturday 5:30 AM to 6:30 PM. OFF-LIMIT AREAS INCLUDE: All bedrooms, one bath, laundry room, garage and side yards · The facility is NOT operating within the licensed capacity and appropriate ratios-Assistant Nayeli Delira-Martinez was home alone with a total of 12 day-care children. · The Licensee is present in the home and has ensured that children in care are supervised at this time · When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children · A working telephone is present · Appropriate fire extinguisher and smoke detector present and were tested by the applicant during this inspection. No carbon monoxide detector present as stated by Ms. Hernandez. · All hazardous items are inaccessible, this includes: detergents, cleaning compounds, medications and other items which could pose a danger to children · Storage of poisons is inaccessible to children and locked · There is a properly barricaded fire place · No guns or weapons present as stated by the Licensee. Licensee understands all guns, weapons and ammunition must be key-locked separately and made inaccessible per Title 22 regulations. · Single story home · Home is clean and orderly, with heating and ventilation for safety and comfort

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Ana Noble	TELEPHONE: (951) 782-3278
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HERNANDEZ FAMILY DAY CARE	FACILITY NUMBER: 330929355
	VISIT DATE: 06/03/2019

NARRATIVE

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· Safe and appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas are fenced or appropriate supervision is present
· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted
· Pediatric CPR and First Aid Card expire on 4/18/2019
· Health & Safety Certificate - completed
· There are no bodies of water at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.
· Clean, safe and age appropriate toys
· Documentation of fire drills on file 9/14/2018
· Each child’s file contains a copy of the emergency information card with required information
· The licensee was asked to provide information in regard to having an association to any licensed community care facility. The licensee states she is not associated to any other licensed facility.
· Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed. All individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. This was verified on 5/31/19.
· The Department was granted inspection authority as required by the Health and Safety Code
· Facility is not currently providing 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
· For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program:

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Ana Noble	TELEPHONE: (951) 782-3278
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HERNANDEZ FAMILY DAY CARE	FACILITY NUMBER: 330929355
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/03/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/28/2019 Section Cited CCR 102417(g)(9)(A)	1 2 3 4 5 6 7	Operation of a Family Child Home. Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement was not met by evidence of: Last documented drills was on 9/14/2018. This is a potential safety risk for children in care.	1 2 3 4 5 6 7	Licensee agrees to conduct fire and disaster drills, and document on log. Submit proof to the Department by 6/28/19.
	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
	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: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Ana Noble	TELEPHONE: (951) 782-3278
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HERNANDEZ FAMILY DAY CARE	FACILITY NUMBER: 330929355
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/03/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/04/2019 Section Cited CCR 102416.5(e)	1 2 3 4 5 6 7	Staffing Ratio and Capacity. Staffing Ratio and Capacity: If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement was not met as evidence by: Upon LPAs arrival, Assistant	1 2 3 4 5 6 7	Licensee arrived approximately 10 minutes after LPAs arrival. Licensee agreed to submit a written plan on how she will prevent this from occurring in the future submit to the Department by 6/4/2019.
	8 9 10 11 12 13 14	was alone with a total of 12 day-care children. This pose an immediate health and safety treat to the children in care.	8 9 10 11 12 13 14
Type A 06/04/2019 Section Cited HSC 1597.543	1 2 3 4 5 6 7	AB2386 - Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. This requirement not met by evidence by: No carbon monoxide present in the home per Licensee.	1 2 3 4 5 6 7	Licensee agrees to purchase a carbon monoxide detector and install it. Picture showing installation and receipt of purchase requires to be submit by 6/4/19.
	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: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Ana Noble	TELEPHONE: (951) 782-3278
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019

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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HERNANDEZ FAMILY DAY CARE	FACILITY NUMBER: 330929355
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/03/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/28/2019 Section Cited HSC 1596.8662(B)(1)	1 2 3 4 5 6 7	AB1207. On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter traingin every two	1 2 3 4 5 6 7	Licensee agrees to submit proof of completed training of mandated reporter for Spouse/Assistant to Department by 6/28/2019. http://mandatedreporterca.com/
	8 9 10 11 12 13 14	years. This requirements was not met by evidence by: Licensee and Assistant did not have certificate of completion of required mandated reporter training. This is a potential risk to children if not completed.	8 9 10 11 12 13 14
Type B 06/28/2019 Section Cited CCR 102416(c)	1 2 3 4 5 6 7	Personnel Requirements.The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement was not met by evidence of: Licensee and Assistant card	1 2 3 4 5 6 7	Licensee agrees to register and submit proof of valid First Aid/CPR cards for Licensee and Assistant. Submit proof of completion by 6/28/19.
	8 9 10 11 12 13 14	were expired as of 4/18/2019.	8 9 10 11 12 13 14

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: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Ana Noble	TELEPHONE: (951) 782-3278
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019

LIC809 (FAS) - (06/04)

Page: 5 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HERNANDEZ FAMILY DAY CARE	FACILITY NUMBER: 330929355
	VISIT DATE: 06/03/2019

NARRATIVE

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http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Rick-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep
The following was reviewed with the licensee(s):
- AB 2084 - Nutritious Beverages in Child Care Facilities effective January 1, 2012
- AB 1819 – Smoking prohibition on the premises of Family Child Care Homes, effective January 1, 2015
- AB 2621 – Public information posted on the internet, effective January 1, 2015
- AB 2386 – Carbon Monoxide Detector Regulations, effective January 1, 2015
- AB 2236 – Civil Penalties, effective July 1, 2015
- SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016
- AB290 – Child Nutrition, effective January 1, 2016
- SB792 – Immunization requirements for staff, volunteers, effective September 1, 2016
- AB2231 (2016) – Increased Civil Penalties, effective July 1, 2017
NOTE: Repeat violations are defined as a violation of a previously cited statutory or regulatory Section and/or subsection within 12 months prior.
- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov
- Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov
- Responsibility to know the regulations for anyone providing care
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility’s phone numbers must be on file at all times.
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills are to be conducted every six months
- Responsibilities of being a mandated reporter

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Ana Noble	TELEPHONE: (951) 782-3278
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019

LIC809 (FAS) - (06/04)

Page: 6 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HERNANDEZ FAMILY DAY CARE	FACILITY NUMBER: 330929355
	VISIT DATE: 06/03/2019

NARRATIVE

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- Baby walkers, bouncy seats, exersaucers and other similar items are prohibited
- The licensee is urged to visit the U.S. Consumer Product Safety Commission webpage at www.cpsc.gov to ensure that equipment purchased for the day care has not been recalled.
- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
- Access to forms & Regulations for Family Child Care Homes online at www.ccld.ca.gov.
- Please subscribe at childcareadvocatesprogram@dss.ca.gov to receive Department updates. They will be sent directly to your e-mail account once you have set up an account. This website can also be accessed through www.ccld.ca.gov
- The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).
vPlease completed Mandated Reporter Training at the following link: http://mandatedreporterca.com/

See LIC809D for cited deficiencies. Appeal rights discussed and a copy of this report was provided to the licensee on this date. IF a Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

During the exit interview, the LICENSEE, Elizabeth Hernandez, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279, LIC508 and TB Screen and have your child submit for LIVESCAN background clearance. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Ana Noble	TELEPHONE: (951) 782-3278
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019

LIC809 (FAS) - (06/04)

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