376628618-4-21-2020-20-CC-LGAO-BNW2Y8-20200421174816

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376628618
Report Date: 04/21/2020
Date Signed: 04/21/2020 05:48:24 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, ROSA FAMILY CHILD CARE		FACILITY NUMBER:	376628618
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	04/21/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Rosa Hernandez & Maritza Hernandez		TIME COMPLETED:	05:45 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	LPA, Luigi Gargaro, conducted an announced prelicensing inspection for a relocation with the applicant to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. The visit was conducted as a tele- inspection via Zoom due to COVID-19. Ms. Hernandez speaks and understands English but it is not her primary language. Her daughter, Maritza Hernandez, however, was present during the visit and provided translation when needed between the analyst and the applicant and assisted with the visit. The one story home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher and smoke and carbon monoxide detectors meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. The applicant was asked whether she had any bodies of water or weapons in the home and she replied no. CPR and First Aid expire on March of 2022 for both the applicant and her assistant daughter. A review of staff records 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. Applicant rents the home and provided proof of control of property in the form of a lease agreement that was submitted with her original application. Applicant will be using the following rooms for childcare: the kitchen, the living room, the first and second bedrooms and the home bathroom. Off limits is the third home bedroom with inclusive bath which is made that way with a door knob cover that is installed on its door handle. The home has a fenced backyard available for outdoor activities. The yard has a storage shed that that contains the applicant's personal items. The shed is made off limits with a secured barricade gate. As the gate is not a full height gate, applicant will be required to provide direct supervision at all times when children are in the yard and ensure no hazardous items are placed in there until a larger gate is installed or a completely secured storage shed replaces the current one. The home also has a gated front yard that is secure and free of hazards and may be used at the applicant's discretion as an additional outdoor play area.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020

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, ROSA FAMILY CHILD CARE	FACILITY NUMBER: 376628618
	VISIT DATE: 04/21/2020

NARRATIVE

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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 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 and applicant discussed California Megan's Law and he provided applicant with the website address: www.meganslaw.ca.gov for her to review information regarding her facility on a regular basis.

No corrections are needed, however, applicant is still required to obtain an updated eight hour EMSA approved Preventative Health certificate that includes the additional one hour nutrition component. Applicant has 90 days, until 07/21/20, within which to obtain the certificate and submit it to analyst. Once received, license will be changed from a provisional one to a regular status one. A provisional license for eight was issued today.

Analyst reviewed the report with applicant during the tele-inspection. A copy of the report will be e-mailed to applicant and she was advised that acknowledgement of the receipt of the report is to be received within twenty-four hours.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020

LIC809 (FAS) - (06/04)

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