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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376615390
Report Date: 11/06/2019
Date Signed: 11/06/2019 03:55:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HERNANDEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
376615390
ADMINISTRATOR:HERNANDEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 475-2348
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:14CENSUS: DATE:
11/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Maria HernandezTIME COMPLETED:
04:00 PM
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LPA Castellon made an unannounced Annual/Random inspection and met with licensee Maria Hernandez. There were 4 children in care. Also present was the license''s husband and adult son. Ratios and capacity are appropriate. LPA Castellon conducted a tour of the home to ensure compliance with standards established in Title 22 licensing regulations. Licensee Hernandez is using the following area for daycare: entire home except for the bedrooms. Licensee was reminded that she may not make any changes to approved daycare areas prior to Department approval.
All cleaners, toxins, medications, poisons and other hazardous substances are inaccessible to children in care and are located in off limits area. Licensee has provided safe toys, play equipment and materials. Home is clean, orderly with adequate heating and ventilation for safety and comfort. Licensee states that there are no firearms or other weapons in the home. There are no bodies of water at the facility. Fire extinguisher, carbon monoxide detector and smoke detector are present in the home and meet State Fire Marshall standards. Licensee has all appropriate forms posted. Fully fenced front yard and side yard are used for outdoor play. Licensee was reminded to provide direct supervision when these areas are in use. Emergency disaster drills are practiced and documented. Children’s records were reviewed. First aid/ CPR certificates are valid.
Licensee has provided parents or representatives with a copy of the Family Child Care Notification of Parent’s Rights. There are no new adults living or working in the home over the age of 18 years. All adult residents and helpers have submitted or been cleared for criminal record and child abuse index clearances or exemptions.

LPA reminds licensee of the following: required departmental documents, supervision, clearances, emergency drills, child passenger law, unusual incident/injury reporting, mandated reporting, Assembly Bill 633, SIDS, Shaken Baby Syndrome, and Megan's law. Licensee is reminded that corporal
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HERNANDEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376615390
VISIT DATE: 11/06/2019
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punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation. New adult immunization requirements have been discussed and licensee has met requirements.

Mandated Reporter Training has been completed.

Incidental Medical Services (IMS) policy was discussed. Facility does not provide care for children who require IMS. 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

Forms and trainings may be obtained at ccld.ca.gov

No citations issued on this date.

SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
LIC809 (FAS) - (06/04)
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