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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414668
Report Date: 10/06/2022
Date Signed: 10/06/2022 03:49:47 PM


Document Has Been Signed on 10/06/2022 03:49 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:HERNANDEZ, MARIA DEL PILARFACILITY NUMBER:
434414668
ADMINISTRATOR:HERNANDEZ, MARIA DEL PILARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 704-6266
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:14CENSUS: 8DATE:
10/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:24 PM
MET WITH:Maria Del Pilar HernandezTIME COMPLETED:
03:50 PM
NARRATIVE
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On Thursday 10/06/2022 at approximately 12:25PM, Licensing Program Analyst (LPA) Sabina Dodoo met with licensee Maria Del Pilar Hernandez for an UNANNOUNCED ANNUAL REQUIRED INSPECTION for a Large Family Child Care Home. Present for the inspection were the Licensee who is fingerprint cleared and her two aides Keanu Baker, and Marielle Macuil Hernandez who are also fingerprint cleared and associated. The total children enrolled are 8 and the census was 8 children at the time of the inspection. The Family Child Care Home is within ratio. The Family Child Care Home was toured to conduct a Health and Safety Inspection. The center currently operates Monday through Friday from 8:00am to 5pm.

PHYSICAL PLANT: The Family Child Care Home is a single-story residential home with three bedrooms and one bathroom. The entrance of the Family Child Care Home is the main door of the home. The indoor patio has been converted into a classroom. The outdoor patio is a shaded area where the children eat. One of the bedrooms has been converted into a napping room. LPA observed children napping on sleeping cots and cribs. LPA observed the kitchen area to be neat, clean, and sanitary. LPA observed one bathroom that is in operable condition. LPA also observed a changing table that is within arms-reach of a sink. LPA observed the bulletin board (parent’s rights, emergency disaster plan, earthquake drills, PUB269, and facility license). All hazardous materials and toxins are kept out of reach from children and are not accessible. This Family Child Care Home has one fully charged fire extinguisher 3A-10- 40 BC, one carbon monoxide detector, one smoke detector, a telephone and a fully stocked first aid kits. The furniture around the activity area and outdoor area are all child proof and adequate for children to use. The learning materials are organized, and toys are kept in safety bins and cabinets for easy access for the children.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina DodooTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2022
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 10/06/2022 03:49 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: HERNANDEZ, MARIA DEL PILAR
FACILITY NUMBER: 434414668

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review)], the licensee did not comply with the section cited above in 2 out of 3 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/14/2022
Plan of Correction
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Licensee must complete the CPR/First Aide Training no later than 10/14/2022. Licensee must submit a copy of the CPR/First Aide to LPA via email at: Sabina.Dodoo@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina DodooTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HERNANDEZ, MARIA DEL PILAR
FACILITY NUMBER: 434414668
VISIT DATE: 10/06/2022
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On Limit Areas are: the indoor patio( converted into activity room), the bedroom that is used for napping, the kitchen, the outdoor patio, and the backyard.

Off Limit Areas are: the living room, 2 bedrooms and the garage.

FOOD & SNACK: The children have the option to bring lunch from home. Licensee provides AM/PM snacks and lunch. Licensee provides water to the children in water cups labeled with their names.

OUTDOOR: LPA Dodoo observed the backyard(outdoor play area) which consist of a play structure with 3 slides. The play structure is affixed to the ground. There is a green cushion material all around the play structure and play area to absorb falls. There is also a playhouse and toy cars for children to play with. The outdoor play area is also fenced all around with secured gates. There are no bodies of water on the premises and no firearms.

RECORDS: LPA Dodoo reviewed 4 children’s file and 3 staff files and documented them on LIC 857 and LIC 859. A current roster was viewed by LPA. LPA obtained a copy from Licensee. The staff interview was completed with Licensee Maria Del Pilar Hernandez. Licensee has not completed the Health and Safety training and CPR/First Aid is not current. Licensee is following the immunization laws and has not completed the mandated reporter training. A Technical Assistance was given(Please see LIC 9102TA for details). The Licensee has conducted and documented the fire and disaster drills twice a year and the last conducted drill was in August 2022. All required forms are posted and visible for public view.

Incidental Medical Services (IMS) policy was discussed. This facility is not providing IMS (Incidental Medical Services) to children in care currently. If 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

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina DodooTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HERNANDEZ, MARIA DEL PILAR
FACILITY NUMBER: 434414668
VISIT DATE: 10/06/2022
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Licensee was reminded that all adults 18 and over working in Child Care Center, 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 Child Care Center. 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 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.

Licensee was reminded of the responsibility as a mandated reporter and the training must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624 within 7 business days.

There is one deficiency cited during today’s inspection. A Type B violation is being given due to the Licensee or the aides not having a valid CPR First Aide.(Please see LIC 809 D for Details). The Plan of Correction is due on Friday 10/14/2022. A Notice of Site Visit was given and must remain posted for 30 days. Exit Interview and staff interview was conducted with Licensee (Maria Del Pilar Hernandez). A copy of Appeal Rights was provided. This report shall remain on file for the next 3 years.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina DodooTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
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