334844541-11-20-2019-10-CC-SBRR-BJ4PHM-20191120102010

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334844541
Report Date: 11/20/2019
Date Signed: 11/20/2019 10:20:35 AM

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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	HERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	334844541
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	11/20/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	09:38 AM
MET WITH:	Alexxis Hernandez		TIME COMPLETED:	10:30 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	On 11/20/2019 at 9:38 AM, Licensing Program Analyst (LPA) Susan Brewer, arrived at the facility for the purpose of conducting a follow-up visit, for the case management inspection that took place on 10/18/2019. The licensee Alexxis Hernandez, has applied to increase her capacity to that of a Large Family Child Care Home and initiated the request for a visit. LPA S.Brewer, was greeted and granted access into the facility by the licensee A. Hernandez. LPA S. Brewer, took a census of 6 children in care, toured the facility, inside and out, records were reviewed and the following was observed: · Normal days and hours of operation are: Monday - Friday, 6:00 AM to 7:00 PM for children Ages 0-14 years old. - Responsibility to know the regulations for anyone providing care - Inaccessibility of hazards must be constantly re-assessed depending on the children in care - Failure to meet the posting requirements shall result in an immediate $100 civil penalty. - Documentation of fire & earthquake drills to be conducted every six months - Baby walkers, bouncy seats, exersaucers and other similar items are prohibited - The applicant is urged 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 online at www.ccld.ca.gov.

SUPERVISOR'S NAME: Telma Sandoval	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 334844541
	VISIT DATE: 11/20/2019

NARRATIVE

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- Please subscribe at www.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).

It was discussed during the initial case management visit on 10/18/2019, that before licensure, the following needs to be corrected/completed by 11/18/2019:

VERIFIED: Update Section 9 on the 279A Application for Days and Hours of operation.
VERIFIED: A qualified assistant is hired prior to operating at a large capacity day care home. a.) 09/19/2019 Associated; b) 10/27/2019 Completed 1st aid/CPR; c) 11/02/2019 Mandated reporter training completed; d) 11/10/2019 Health/Safety/Nutrition training completed; e) 11/12/2019 received employee records: LIC508, LIC9108, Immunization records, CDL, LIC9052-Employee Rights.
VERIFIED: The licensee has a tomato plant growing in the flower bed of the back yard, was removed.

All corrections have been completed with proof sent to licensing, as well as verified on 11/20/2019. The application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12, or 14 with parent notification.

· No guns or weapons present as of 10/18/2019. LICENSEE UNDERSTANDS ALL GUNS, WEAPONS AND AMMUNITION MUST BE KEY-LOCKED SEPARATELY AND MADE INACCESSIBLE PER TITLE 22 REGULATIONS.

No Civil Penalty has been assessed during this inspection.

SUPERVISOR'S NAME: Telma Sandoval	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 334844541
	VISIT DATE: 11/20/2019

NARRATIVE

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During the exit interview on 11/20/2019, the LICENSEE Alexxis 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.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.

A copy of this report was reviewed and provided to the Licensee Applicant Alexxis Hernandez, by LPA S.Brewer, on 11/20/2019 and must be made available to the public upon request for the next 3 years.

SUPERVISOR'S NAME: Telma Sandoval	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

LIC809 (FAS) - (06/04)

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