364806517-2-3-2020-12-CC-SMOA-BLFVDZ-20200203152135

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364806517
Report Date: 02/03/2020
Date Signed: 02/03/2020 03:21:51 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	HERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	364806517
ADMINISTRATOR:	HERNANDEZ, ELAINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 885-1511
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92307
CAPACITY:	14	CENSUS: 1	DATE:	02/03/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Elaine Hernandez licensee		TIME COMPLETED:	03:30 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) Steven Montoya met with licensee (Elaine Hernandez). The purpose of the inspection is to conduct an Annual/Random Inspection. Licensee is license to provide care and supervision for a Large Family Child Care Home (FCCH) for the capacity of 14 children. There are currently (9) children enrolled in the family child care. Present during the time of this inspection is licensee and spouse, 1 family child care child. Pre licensee residing in the home on (Date) is license, spouse and minor children. Per licensee all adults residing in the home has a Criminal Record Clearance. LPA toured the areas of the home utilized for the Family Child Care to ensure the home is incompliance with Community Care Licensing Title 22 Regulations. The days are hours of operation are Monday thru Friday 7 am to 6 pm. The home is set-up as follows: This is a single story house with 3 bedrooms, 2.5 bathrooms, kitchen/dining room, living room, and de attached garage. Per Licensee the playroom, kitchen, 1 bathroom, and backyard is utilized for the family child care activity area. Per licensee off-limit areas of the home is the 3 bedrooms, 2 bathrooms and de attach garage.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 364806517
	VISIT DATE: 02/03/2020

NARRATIVE

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The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. LPA observed all items are made inaccessible to children during the time of this inspection. LPA observed age appropriate safe toys and napping equipment on the premises. LPA observed all electrical outlets made inaccessible to children with safety covers. The home has a current roster of the children in care. There are (1) children present during today’s inspection. LPA tested hot water at a safe tempeture between 105-120 degrees. Per licensee, there are no weapons or firearms on the premises. LPA did not observe a swimming pool or bodies of water on the premises. LPA observe in the backyard a metal swing set which is anchored in the ground.

LPA observed the required fire extinguisher (2A10BC) fully charged, smoke detectors and carbon monoxide devices tested operable. The First Aid Kit was observed complete with supplies and first aid manual.
LPA observe licensee has current Pediatric CPR and First Aid Training with expiration date (Not available) 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training. Licensee does not have proof of being immunized against influenza, pertussis and measles.
Per licensee transportation is being provided for children. LPA observe licensee valid California driver license with the expiration date of 07-11-2024, vehicle insurance with expiration date 07-24-2020 and vehicle registration with the expiration date of 04-26-2020. Per licensee meals and snacks are being provided to children.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 364806517
	VISIT DATE: 02/03/2020

NARRATIVE

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LPA reviewed # children’s records. LPA reviewed the child care facility roster and the fire drills, earthquake drills log and documentation for both. Incidental Medical Services (IMS) were discussed. Per licensee, the facility is not currently providing IMS. LPA informed licensee to refer to IMS information in the 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.

The following information was discussed with the licensee:
· Mandatory Forms for the children’s files and provider’s files.
· Requirements for fire drills, earthquake drills and documentation for both.
· Role and responsibilities of being a mandated reporter was discussed.
· Licensee was made aware that it is their responsibility to know and review updates/regulations and forms online at www.ccld.ca.gov as well as anyone who assists in providing care.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 364806517
	VISIT DATE: 02/03/2020

NARRATIVE

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· The licensing department must have the facility’s phone number. If the phone number is changed, the licensing department must be notified.
· Licensee is aware that all adults 18 years and older living in the home or visiting for extended periods of time should have criminal background clearances. Failure to comply will result in Civil Penalty assessments.
· On January 1, 2018 or before March 30, 2018, a person who, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the on-line mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatedreporterca.com
· AB 290 - for each new license issued, at least one director or teacher at a child care center or family child care home shall have at least one hour of childhood nutrition training;
· Senate Bill AB 2231 Civil Penalty Amount Changes. Changes Effective 7/1/2017.
· Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). **In addition; A copy of this report must be provided to the authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months.
· The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is in care.
· Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 364806517
	VISIT DATE: 02/03/2020

NARRATIVE

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· Licensee is made aware that Title 22 Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home, and in those areas of the family day care home where children are present (24/7 ban).
· **§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (a) (1) 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
· **Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
· Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed child care facility are aware of situations that present the greatest danger to children.
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· State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.
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· Safe Sleep in Child Care: Resources can be found on our website at http://www.cdss.ga.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 364806517
	VISIT DATE: 02/03/2020

NARRATIVE

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· Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.·
· Licensee advised visit www.shotsforschool.org for Immunization information.
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· Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov. Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe”. ·
· The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited:
Exit interview conducted with Licensee (Name). A copy of this report, notice of site inspection, Appeal Rights (LIC 9058), Confidential Names List (LIC 811) were given and explained during this inspection. Licensee’s signature on this form acknowledges receipt of these rights.
Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in visible location the authorized representatives of children.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 364806517
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/03/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/14/2020 Section Cited	1 2 3 4 5 6 7	1597.541 (b) Age-appropriate immunization requirements; adoption of regulations (b) All family day care homes for children shall maintain evidence that enrolled children have met the age-appropriate immunization requirements adopted pursuant to this section.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: LPA observations of the children files. Type B This poses a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
Type B 02/14/2020 Section Cited	1 2 3 4 5 6 7	1597.622 Employee and Volunteer Immunization. (c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: LPA observations of the personell files. Type B This poses a potential risk to the health and safety of children in care.	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: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020

LIC809 (FAS) - (06/04)

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