<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215500
Report Date: 10/03/2022
Date Signed: 10/03/2022 04:28:01 PM


Document Has Been Signed on 10/03/2022 04:28 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 RIOS FAMILY CHILD CAREFACILITY NUMBER:
426215500
ADMINISTRATOR:JUANA HERNANDEZ RIOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 928-0173
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 8DATE:
10/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Juana HernandezTIME COMPLETED:
04:45 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
Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

On 10/3/2022, at 1:30 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Required Annual Inspection and met with Juana Hernandez, Licensee, and Anett Madrigal, Assistant. The purpose of the visit was discussed with the licensee and together we toured the inside and outside of the home. LPA observed 7 children and 1 infant napping at the time of the inspection.

The main day care areas are living room, dining room, kitchen, and bathroom. LPA observed the day care area to be clean and orderly. LPA observed age appropriate books, toy, games, tables and chairs. LPA observed the off-limits areas which include the 3 bedrooms, 1 bathrooms and Accessory dwelling unit (ADU),secured with doorknob covers, gates and locks. The backyard is completely fenced. LPA observed age appropriate toys, bikes, play structure and playhouses LPA observed a medium dog secured in the backyard. No bodies of water were observed.

Per licensee, the garage was converted into an ADU on 3/31/2022, without reporting to CCLD. Licensee stated that she did not have access into the ADU at the time of the inspection. Per licensee, Alejandro Alcala, Licensee's brother-in-law, age 46, has been residing in the ADU since 9/24/2022. LPA advised the licensee that Alejandro Alcala does not have a criminal record clearance, and is not associate to the FCCH license. Mr. Alcala is currently working at a winery in Santa Maria, and licensee does not have a date for when the brother-in-law will be leaving the FCCH.

Licensee stated that there are no weapons/ammunition in the home. Licensee stated she does not hold a foster family license. LPA reviewed the facility roster. The fire extinguisher was observed and was serviced May 16,

THIS REPORT CONTINUES ON LIC 809C & LIC 809D
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


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 RIOS FAMILY CHILD CARE
FACILITY NUMBER: 426215500
VISIT DATE: 10/03/2022
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
26
27
28
29
30
31
32
2022. Per the licensee the carbon monoxide detector and smoke alarm that were tested on 9/12/2022. Licensee and assistant are current with immunization required per SB 792. The last Safety drill conducted and documented was 9/22/2022. Licensee is current with CPR and First Aid which expires January 8, 2023. Licensee completed the Mandated Reporter Training required per AB 1207, on 12/16/2021.

Licensee is not providing Incidental Medical Services. 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: htttp://www.ada.gov/childqanda.htm

LPA reviewed with Licensee the Safe Sleep Regulation (PIN 20-24-CCP-SP), What is Carbon Monoxide, The Effect of Lead. LPA provided a Handout for Reporting Child Abuse and Neglect Training provided on line at www.ccld.ca.gov.

Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs), Title 22 & Health & Safety Codes which can be accessed on-line athttps://www.cdss.ca.gov/inforesources/child-care-licensing

Today’s visit was conducted in Spanish. Today, deficiency cited under Title 22 Division 12, Spanish Appeal rights given. Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 10/03/2022 04:28 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 RIOS FAMILY CHILD CARE
FACILITY NUMBER: 426215500

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2022

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 LPAs observation and interview with licensee, who stated Alejandro Alcala, Licensee's brother-in-law, age 46, has been residing in the ADU since 9/24/2022. LPA advised the licensee that Alejandro Alcala does not have a criminal record clearance, and is not associate to the FCCH license. Mr. Alcala is currently working at a winery in Santa Maria, and licensee does not have a date for when the brother-in-law will be leaving the FCCH, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/04/2022
Plan of Correction
1
2
3
4
Please correct immediately.

An immediate civil penalty of of $500.00 is assessed.
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 MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 10/03/2022 04:28 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 RIOS FAMILY CHILD CARE
FACILITY NUMBER: 426215500

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.3(a)(1)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (1) Conversion of a garage (either attached or detached) into a "child care" room.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on licensee, stated that the garage was converted into an ADU on 3/31/2022, without reporting to CCLD, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/10/2022
Plan of Correction
1
2
3
4
Licensee will submit a written statement on licensee will prevent future incidents to CCLD by August 22, 2022.

Martina.Jimenez@dss.ca.gov
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 MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4