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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566211693
Report Date: 02/08/2024
Date Signed: 02/08/2024 04:20:19 PM


Document Has Been Signed on 02/08/2024 04:20 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
566211693
ADMINISTRATOR:MAXIMA HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 796-1133
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:14CENSUS: 10DATE:
02/08/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Maxima HernandezTIME COMPLETED:
04:20 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 February 8, 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced 3-Year required inspection at the above-mentioned Family Child Care Home (FCCH). LPA met with Licensee Maxima Hernandez and informed them the purpose of the inspection. LPA in the company of the Licensee toured the interior and exterior of the FCCH. At the time of the inspection there were 10 children present with 2 assistants present.

LPA observed the interior of the FCCH to be clean and orderly LPA observed age appropriate toys and furnishing for children in care. LPA observed the kitchen area to accessible to children and to be free of hazardous materials. LPA observed the sharps to be stored in a kitchen cabinet beyond the reach of children in care. LPA observed the medications to be stored on an elevated surface beyond the reach of children. Licensee informed LPA that cleaning supplies are stored in the garage which remains locked and inaccessible to children in care. LPA observed the bathroom used for children to be clean and free of toxins. LPA reminded Licensee to ensure any toxins or hazardous materials are not accessible to children in care.

LPA observed required licensing forms and documents posted on a wall in the hallway of the FCCH. LPA multiple smoke detectors and a carbon monoxide detector. A carbon monoxide and smoke detector were tested at 11:12AM and found to be operational. LPA observed the FCCH to have a regulation fire extinguisher which was serviced 10/4/2023. LPA reminded Licensee to either service or purchase a regulation fire extinguisher annually. Licensee informed LPA there are no fire arms in the FCCH.

LPA observed the backyard to be completely enclosed by a fence. LPA observed exit way of the yard to be secure. LPA observed age appropriate toys and furnishing for children in care. LPA observed 2 storage shed in the backyard. In one shed LPA observed additional equipment for children and the other shed to be locked and inaccessible to children in care. LPA did not observe any bodies of water on site.

CONTINUED PAGE 2

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani GonzalezTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024
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 5


Document Has Been Signed on 02/08/2024 04:20 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 566211693

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

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 in 1 out of 1 which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2024
Plan of Correction
1
2
3
4
Licensee agrees to ensure A1 gets criminal record clearance and does not directly supervise any children until individual receives clearance. Proof of live scan request form will be submitted to giovani.gonzalez@dss.ca.gov by 2/9/24.
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: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani GonzalezTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5


Document Has Been Signed on 02/08/2024 04:20 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 566211693

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and interview, the licensee did not comply with the section cited above in 1 out of 1 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/22/2024
Plan of Correction
1
2
3
4
Licensee will submit proof to LPA that they are conducting 15 minute checks for all infants by 2/22/2024. Licensee will submit proof by email at giovani.gonzalez@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: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani GonzalezTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 566211693
VISIT DATE: 02/08/2024
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
LPA reviewed children's records which were found to be current and complete. LPA reminded Licensee that it is their responsibility to ensure that children's records are complete. LPA asked Licensee if they have been conducting Safe Sleep 15 minute checks and Licensee stated that they were not. 1 Type B deficiency is being cited on the attached LIC809D. LPA reviewed assistant files as well. LPA observed that 1 assistant did not have a Mandated Reporter Training certificate available for review. LPA reviewed Licensees records . Licensee's Mandated Reporter Training was completed 11/3/2022 (Expires 11/3/2024) and Pediatric CPR/First Aid (EMSA approved) was completed 2/2/24. LPA reminded Licensee that it is their responsibility to ensure that they have current training and certification. The last emergency drill conducted was on 9/6/2023.

Based on file review 1 adult who resides in the home and provides care and supervision does not have a a criminal record clearance. 1 Type A deficiency is being cited on attached LIC809D.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.



Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [or facility representative] 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.
CONTINUED PAGE 3
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani GonzalezTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 566211693
VISIT DATE: 02/08/2024
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
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee [or facility representative] was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Today, deficiencies are being cited under Title 22 Division 12 Appeal rights given. Civil penalty was assessed. 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

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Maxima Hernandez.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani GonzalezTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5