376626801-9-9-2020-20-CC-RGOU-BTB25C-20200909170520

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376626801
Report Date: 09/09/2020
Date Signed: 09/09/2020 05:05:58 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, EUNICE FAMILY CHILD CARE		FACILITY NUMBER:	376626801
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	09/09/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	04:03 PM
MET WITH:	Eunice Hernandez		TIME COMPLETED:	04:30 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	On 09/09/20 4:03 p.m. Licensing Program Analyst (LPA), Rajani Goudreau conducted an unannounced case management, licensee initiated tele-visit. Upon visit, LPA met with licensee, Eunice Hernandez. Also, present in the home at time of visit licensees’ two minor children. No daycare children in care during visit. The home was toured and inspected to ensure an environment safe for the care and supervision of children. Facility operates Monday through Friday from 6:30 a.m. to 6:00 p.m. All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children and poisons are to be locked away. The fire extinguisher, smoke and carbon monoxide detector meet requirements and are operational. LPA observed required postings posted. 2A:10 fire extinguisher present in home and non-expired. Carbon monoxide and smoke detector observed and operational. Children’s toys and play equipment are safe and age appropriate. There are no bodies of water observed by LPA during inspection. Children utilize partial of the front yard for outdoor play. LPA informed licensee to ensure children are supervised at all times during outdoor activities. There are no firearms or other weapons in the home, per licensee. Current pediatric CPR and first aid certifications are on file. Preventative Health Practices certificate is on file. Primary telephone is a cell phone which is operational. A review of clearances on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee rents the facility and has provided proof of control of property. Landlord notification on file. LPA informed licensee if she will care for more than 12 children a landlord consent, LIC9149 will have to be on file. Licensee has met immunization requirement, per SB792 and has completed the AB1207 Mandated Reporter Training. Facility self-certification checklist on file. See LIC809 continuation page…

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2020

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: HERNANDEZ, EUNICE FAMILY CHILD CARE	FACILITY NUMBER: 376626801
	VISIT DATE: 09/09/2020

NARRATIVE

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Licensee will use the following areas for childcare: living room & dining room (great room), kitchen, bedroom #2 and bedroom #3, bathroom #1 located in hallway of home and partial of the front yard. Off limit areas of the home include: attached garage, bedroom #1 and bathroom #2 (in bedroom #2), drive way of home and backyard. Off limit areas of the home are made securely inaccessible, per observation.

Fire Clearance was granted on September 01,2020 with the condition the garage is not permitted for childcare.

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 provided 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

LPA discussed California Megan's Law and provided the following to licensee with the following website: www.meganslaw.ca.gov. LPA informed applicant in order to access CCLD-Childcare regulations, licensing forms, pay the annual fee to visit the following website: http://ccld.ca.gov. LPA discussed the following with licensee: to sign up for Quarterly Updates and PINs for one or more programs through our website. Please go to www.cdss.ca.gov and on the right side of your screen click on “Receive Important Updates”, put your email address in and choose which program(s) you would like to subscribe to and click “subscribe. In addition, for questions contact Child Care Licensing duty line at 619-767-2248.

LPA discussed the following with licensee: Max capacity when there is an assistant present: 12 children-no more than 4 infants (birth to 24 months). When caring for 14 children no more than 3 infants. 1 child in kindergarten and 1 child at least 6 years old. When there is no qualified assistant the capacity reverts back to the requirements from a small childcare. You must notify the parents of the children in care when caring for more than 12 children.

An exit interview was conducted with licensee. The following was discussed and will be provided via email to licensee: LIC809, LIC809-C and appeal rights. After final file review; a large family childcare license will be issued and mailed to licensee. LPA informed licensee, once license is received to post in a prominent place in home. COVID-19 State of emergency read receipt notification will be used in place of licensee’s signature.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2020

LIC809 (FAS) - (06/04)

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