376620714-8-7-2019-20-CC-JARL-BETMQH-20190807094846

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376620714
Report Date: 08/07/2019
Date Signed: 08/07/2019 09:48:52 AM

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, MARTHA & JOSE FAMILY CHILD CARE		FACILITY NUMBER:	376620714
ADMINISTRATOR:	MARTHA & JOSE HERNANDEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 582-6049
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY:	14	CENSUS: 11	DATE:	08/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Martha & Jose Hernandez		TIME COMPLETED:	09:50 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	Licensing Program Analyst (LPA) Jo Ann Legaspi conducted an unannounced inspection with the Licensees. The home was toured and inspected to ensure a safe environment for the care and supervision of children. The home consists of five (5) bedrooms, four (4) bathrooms, living room, kitchen/dining room, outside covered playroom/patio and covered backyard. Present in the home were the Licensees, two (2) helpers, ten (10) daycare children and one (1) child related to the Licensees. The fire extinguisher, carbon monoxide/smoke detectors satisfy requirements and are operational. The last safety drill was on 07/30/2019. Hazardous items were secured inaccessible to children. There are no bodies of water in the home. There are no weapons in the home, per the Licensee. A review of staff records indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. First Aide and CPR certifications expire in April 2021. Reviewed children records were observed to be complete. Licensee has provided adequate space for the children to eat, sleep and play within the home. The living room, dining room/kitchen, one (1) bedroom, one (1) bathroom, outside covered playroom/patio, covered backyard and fenced front yard are used for child care. The Licensee has enough toys and available equipment. All equipment that is used should be used only as intended by the manufacturer. The home has both a fenced back and front yard available for outdoor activities. The Licensees acknowledge continuous visual supervision will be given to children whenever engaged in outdoor activities. LPA provided and reviewed with Licensee Provider Information Notice (PIN) 19-06-CCP, which states the US Consumer Product Safety Commission has issued a safety recall of specific sleepers due to several infant deaths. LPA provided Licensee with PIN 19-02-CCP regarding Safe Sleep Awareness, additional written information and information resources about safe sleep techniques. LPA and Licensee discussed those methods of protected slumber. LPA provided and discussed with Licensee PIN 19-08-CCP, which describes new immunization requirements issued by the Department of Public Health. Licensee was also provided with

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

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, MARTHA & JOSE FAMILY CHILD CARE	FACILITY NUMBER: 376620714
	VISIT DATE: 08/07/2019

NARRATIVE

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written information regarding lead exposure as described in Assembly Bill 2370. LPA further provided and discussed with Licensee PIN 19-07-CCP, which provided information regarding radon toxicity and free testing. Also provided to the Licensee was the “Heart and Nutrition” newsletter. Licensee and LPA reviewed these issues. LPA and Licensee discussed California Megan's Law. LPA provided the website: www.meganslaw.ca.gov. The Licensee was advised of their responsibility to be current on all regulatory changes by viewing the Community Care Licensing webpage at www.ccld.ca.gov. LPA advised the Licensee of the Child Care Advocate Program.

The provider was reminded of the following: report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances to avoid civil penalties associated with this requirement; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care.

The 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 Community Care Licensing. 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.

LPA provided the Licensee with the Notice of Site Visit – LIC 9213. The Licensee posted this notice in LPA’s presence.

Based on today's visit, no deficiencies were observed. An exit interview was conducted with the Licensee, who was provided a copy of their Licensee Rights (LIC 9058 1/16). Their signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

LIC809 (FAS) - (06/04)

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