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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423294
Report Date: 05/26/2022
Date Signed: 06/02/2022 08:38:18 AM

Document Has Been Signed on 06/02/2022 08:38 AM - 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:HERNANDEZ-TIJERO, PATRICIAFACILITY NUMBER:
013423294
ADMINISTRATOR:HERNANDEZ-TIJERO, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 965-7175
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
05/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Patricia Hernandez-Tijero and Jaime Hernandez-PerezTIME COMPLETED:
12:00 PM
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This is an amended version of an original report on May 26, 2022

On May 26 2022, Licensing Program Analyst (LPA) Indira Loza met with Licensee Patricia Hernandez-Tijero and Husband Jaime Hernandez-Perez for an unannounced inspection for the purpose of conducting a Random Annual. Present for the inspection were 10 preschool children. The facility operates Monday through Friday from 8:30am to 4:30 pm . The home was toured to conduct a Health and Safety Inspection.

The home is a single story house which is neat and clean with heating and ventilation for safety and comfort. The home consists of the living room, dining room, kitchen, two bedrooms and a bathroom. The off limit areas are the storage shed, detached garage in the backyard, and the two bedrooms. The off limit areas are inaccessible by closed and/or locked doors and visual supervision. The on limit areas are the living room, dining room, kitchen, the bathroom, sun room and the backyard area. The isolation area is the dining room. The outdoor play area is a fenced backyard, which is free from defects or dangerous conditions. There are ample age appropriate toys that are safe and appear to be clean and in good repair. There are no pools, hot tubs or any other bodies of water. LPA did not observe any hazardous materials or toxins accessible to children today. The heater vents and fireplace are blocked to prevent access by children. Lunch and snacks are brought from home. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, carbon monoxide detector, telephone, and fully stocked First Aid Kit.
The Licensee’s Health and Safety training has been completed. Pediatric CPR and First Aid training has been completed and expires May 2023. Fire/disaster drill log is complete with the last drill logged April 2022. All required forms are posted and visible for public view in the child care room. LPA obtained the children’s files, Licensee and assistant's file, and facility roster. All adults have obtained a criminal record clearance and all files were complete.

There were no deficiencies cited during todays visit.

*************************************809-C Continued***********************************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2022
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 3
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HERNANDEZ-TIJERO, PATRICIA
FACILITY NUMBER: 013423294
VISIT DATE: 05/26/2022
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Licensee was reminded that California Law requires Licensee 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 by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com.

Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

There are no children in care who need an IMS plan. 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
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.
**********************LIC 809-C******************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HERNANDEZ-TIJERO, PATRICIA
FACILITY NUMBER: 013423294
VISIT DATE: 05/26/2022
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LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpagehttps://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.

A notice of site visit was given and must remain posted for 30 days.


Exit interview conducted and report was reviewed with Licensee Hernandez-Tijero.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC809 (FAS) - (06/04)
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