406209024-10-31-2022-17-CC-FVEZ-CKQRE5-20221031125657

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406209024
Report Date: 09/21/2022
Date Signed: 10/31/2022 12:57:25 PM

Document Has Been Signed on 10/31/2022 12:57 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	HERNANDEZ FCC AKA BLANCA'S CHILD CARE		FACILITY NUMBER:	406209024
ADMINISTRATOR:	BLANCA HERNANDEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 474-9374
CITY:	OCEANO	STATE: CA	ZIP CODE:	93445
CAPACITY:	14	CENSUS: 2	DATE:	09/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Blanca Hernandez		TIME COMPLETED:	04:36 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 9/21/22, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced One Year Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Blanca Hernandez, Licensee of the FCCH and explained the purpose of the inspection. LPA notes COVID Pre-screening questions were asked of Licensee prior to the inspection. The Licensee's responses suggest the FCCH is void of COVID positive cases. At the time of the inspection, LPA observed two (2) children on site. LPA, in the company of Licensee, toured the interior and exterior of the FCCH. The FCCH’s living room, daycare room, dining room, (1/2) bathroom in the daycare room, garage and part of the backyard is accessible for childcare services. Meanwhile all three (3) bedrooms and the bathroom in the hallway are made inaccessible by means of baby gate. LPA observed one bedroom with one bathroom located on the second floor of this home and observe a baby gate on the first step of the stairway making the area inaccessible. The kitchen is also made inaccessible by means of a baby gate. LPA observed part of yard is made inaccessible by means of a small fence. The FCCH was observed to be clean and orderly. The FCCH has ventilation to afford for the children’s comfort. The FCCH was void of hazardous items. Medication and sharps are stored in an elevated cabinet in the FCCH's kitchen. Cleaning compounds in the FCCH are stored under the kitchen sink and in the garage, both areas are inaccessible to children in care. The bathroom used for childcare is clean and free of toxins. LPA observed a fireplace in the home that is covered by large piece of furniture. Toys, furniture and equipment in the FCCH are age appropriate. Required forms are predominantly posted on the wall of the FCCH. LPA observed both smoke and carbon monoxide detectors in the FCCH. The detectors were tested at 2:02 PM and found to be operable. The FCCH has a regulation fire extinguisher on site which was service on 9/20/22. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The FCCH maintains working telephone services.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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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Document Has Been Signed on 10/31/2022 12:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HERNANDEZ FCC AKA BLANCA'S CHILD CARE	FACILITY NUMBER: 406209024
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102370(d)(1)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in that adult child that lives in the home has not been granted fingerprint exemption and currently lives in the home which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/22/2022
	Plan of Correction
1 2 3 4	Licensee will ensure unclear individual is removed from home and not present during daycare hours. Licensee agrees to provide the department with a summary explaining how she will ensure individual is not in the home and will submit proof to show individual is not in the home during the operation of the daycare via email to Francisca.Velazquez@dss.ca.gov by 9/22/2022.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HERNANDEZ FCC AKA BLANCA'S CHILD CARE	FACILITY NUMBER: 406209024
	VISIT DATE: 09/21/2022

NARRATIVE

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The backyard has cement play area which is enclosed by wood fencing. The fence’s entry/exit gates are secure. Natural shade is provided by trees in the outdoor yard and a canopy. Toy’s furniture and play equipment observed in backyard area are age appropriate and in satisfactory condition. Licensee is reminded to replace toys and equipment in the outdoor area when items start to degrade or are not in good repair. LPA observed no bodies of water on site.

LPA reviewed children's records. The records are current, complete and possessed emergency contact information and immunization records. Licensee has documentation memorializing child sleep checks in intervals of 15 minutes and LIC 9227 for all children under the age of 1 year. A review of the FCCH's fire drill log shows the last drill occurred on 5/11/22. The Licensee's records are also current and complete with pediatric CPR and First Aid certifications expiring on 3/20/23. Licensee’s Mandated Reporter training certificate is valid until 9/22/23. Licensee is reminded to renew certifications and training prior to expirations. The Licensee informed LPA no firearms or ammunition are stored on site.

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

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.
LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an for additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. CONT 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HERNANDEZ FCC AKA BLANCA'S CHILD CARE	FACILITY NUMBER: 406209024
	VISIT DATE: 09/21/2022

NARRATIVE

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During today's inspection, deficiencies were cited under Title 22 Division 12. Please refer to LIC809D for documentation of deficiencies cited. A civil penalty of $500.00 was assessed.

LPA informed licensee, Blanca Hernandez that this report dated 9/21/2022 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA informed the licensee, Blanca Hernandez to provide a copy of this licensing report dated 9/21/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Blanca Hernandez in Spanish as Spanish is the Licensee primary language.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

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