Community Care Licensing

FACILITY NAME:	HERNANDEZ, EVA		FACILITY NUMBER:	444406155
ADMINISTRATOR:	HERNANDEZ, EVA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 724-5369
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 0	DATE:	04/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Eva Hernandez		TIME COMPLETED:	12:30 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

Licensing Program Analyst (LPA), Elizabeth Berumen conducted a Required - 1 Year Inspection. LPA met with Licensee, Eva Hernandez and explained the nature of today's inspection with her. No day care children were present. Per Licensee, the adults who live in the home are herself, her husband, Abrocio Hernandez Sr., son, Ambrocio Hernandez Jr. ,Daughter, Beronica Hernandez. Licensee's 11, and 10 year grandchildren live in the home. Licensee states that she is currently just caring for her two grandchildren. The day-care is open Monday thru Friday from 6:00 AM to 6:00 PM. There are no active waivers or exceptions for this facility. The day-care is a one storey home with five bedrooms, and two bathrooms. Licensee requested to change her capacity from 14 to 8 during today's inspection. No day care children are currently enrolled; LPA observed a roster dated 02/22/2019. No fire drill log was available for review. The fire extinguisher is not the correct size. The smoke detector is not functioning. The carbon monoxide detector was installed during today's inspection. There is a fire place in the living room that is not being used; picture was taken during today's inspection. Licensee states that there are no weapons or firearms in the home. Incidental Medical Services (IMS) policy was discussed. Licensee states that she is not planning to administer any medication at this time. 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 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 reminded licensee 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. Continuation on next page:`

SUPERVISOR'S NAME: Mary Segura TELEPHONE: (408) 324-2152 LICENSING EVALUATOR NAME: Elizabeth Berumen TELEPHONE: (408) 318-1326 LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023

FACILITY NAME: HERNANDEZ, EVA	FACILITY NUMBER: 444406155
	VISIT DATE: 04/28/2023

FACILITY NAME: HERNANDEZ, EVA	FACILITY NUMBER: 444406155
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/28/2023

Type B

Section Cited

CCR

102417(g)(1)

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above; the fire extinguisher is not the correct size. The smoke detector is missing batteries. A 2A10BC or greater is required this poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/05/2023
	Plan of Correction
1 2 3 4	Licensee agrees to purchase a 2A10BC or greater fire extinguisher and send LPA pictures and proof of purchase. A plan of correction visit will be conducted to ensure the smoke detector is working.

Type B

Section Cited

CCR

102417(g)(9)

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review the licensee did not comply with the section cited above; Licensee is missing the emergency disaster plan (LIC610) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/05/2023
	Plan of Correction
1 2 3 4	Licensee agrees to submit a copy of the emergency disaster plan (LIC610) to CCLD (Community Care Licensing) by plan of correction date of May 5, 2023.

SUPERVISOR'S NAME: Mary Segura TELEPHONE: (408) 324-2152 LICENSING EVALUATOR NAME: Elizabeth Berumen TELEPHONE: (408) 318-1326 LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023

Document Has Been Signed on 05/02/2023 01:55 PM - It Cannot Be Edited

FACILITY NAME: HERNANDEZ, EVA	FACILITY NUMBER: 444406155
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/28/2023

Type B

Section Cited

HSC

1596.8662(b)(1)

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and observation the licensee did not comply with the section cited above; Licensee's Mandated Reporter Training is expired which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	Licensee agrees to complete the mandated reporter training by plan of correction date of May 12, 2023. Website for training mandatedreporterca.com

Type B

Section Cited

CCR

102416(c)

(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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above; Licensee's CPR and First Aid is expired which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	Licensee agrees to sumbit valid cpr & first aid certification by plan of correction date of May 19,2023.

SUPERVISOR'S NAME: Mary Segura TELEPHONE: (408) 324-2152 LICENSING EVALUATOR NAME: Elizabeth Berumen TELEPHONE: (408) 318-1326 LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023

Document Has Been Signed on 05/02/2023 01:55 PM - It Cannot Be Edited

FACILITY NAME: HERNANDEZ, EVA	FACILITY NUMBER: 444406155
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/28/2023

Type B

Section Cited

CCR

102419(b)

(b) The licensee shall post the PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster in a prominent, publicly accessible area in the family child care home at all times children are in care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above; The PUB 394 is not posted in a prominent, publicly visible area which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	Corrected during todays inspection.

Section Cited

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

SUPERVISOR'S NAME: Mary Segura TELEPHONE: (408) 324-2152 LICENSING EVALUATOR NAME: Elizabeth Berumen TELEPHONE: (408) 318-1326 LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023