393619809-8-1-2024-53-CC-CPRA-D7QU37-20240801151303

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393619809
Report Date: 08/01/2024
Date Signed: 08/01/2024 03:13:07 PM

Document Has Been Signed on 08/01/2024 03:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	HERNANDEZ, ELVIA & ANTONIO		FACILITY NUMBER:	393619809
ADMINISTRATOR:	HERNANDEZ, ELVIA & ANTONIO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 426-6244
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	14	CENSUS: 7	DATE:	08/01/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Licensee Elvia Hernandez		TIME COMPLETED:	04:00 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 8/1/24, Licensing Program Analyst (LPA) Carla Polanco met with Licensee for the purpose of an unannounced annual inspection with Licensee Elvia Herandez. There were seven children present at the start of inspection. Licensee's operating hours are Monday through Sunday, 23 hours per day. All adults subject to criminal background review have obtained criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the sides of the yard. LPA observed the required postings and a working phone. 2A10BC fire extinguisher meets regulations. LPA observed smoke and carbon monoxide detectors, and verified they were both functional. LPA toured the kitchen area and verified knives were inaccessible to children in care. LPA observed age appropriate toys for children. LPA observed a restroom and verified that hazardous and toxic items were inaccessible to children in care. Licensee stated there are no weapons in the home. Outdoor play space is fenced. There are no bodies of water on the premises. *Continues on LIC809-C......*

SUPERVISOR'S NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Carla Polanco Rivera	TELEPHONE: (916) 212-0752
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HERNANDEZ, ELVIA & ANTONIO	FACILITY NUMBER: 393619809
	VISIT DATE: 08/01/2024

NARRATIVE

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Children's files were reviewed. Emergency information and required immunization records were on file. LPA observed a current roster and documentation that a fire drill is conducted at least once every six months. Licensee's immunization records are available in the facility file. Current EMSA pediatric CPR and First Aid certification was verified and expires 01/2025 and Child Care Provider Mandated Reporter certification was verified and expires 03/2026. Licensee provided copy of liability insurance which is $300,000 for every occurrence.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA observed 15 min infant napping log for infants 24 months and under. LPA discussed LIC 9227 Individual Sleeping Plan for infants under 12 months. Licensee states that she is not caring for infants under 12 months at this time.

This provider is currently providing Incidental Medical Services (IMS) to children in care. LPA reviewed storage of medication, and child personnel records. 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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN). Licensee stated that she receives the PIN's.

Exit interview was conducted and the report was reviewed with the licensee. A notice of site visit was provided and posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.

SUPERVISOR'S NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Carla Polanco Rivera	TELEPHONE: (916) 212-0752
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024

LIC809 (FAS) - (06/04)

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