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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610561
Report Date: 09/08/2021
Date Signed: 09/08/2021 11:53:41 AM

Document Has Been Signed on 09/08/2021 11:53 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HERNANDEZ, JANET FAMILY CHILD CAREFACILITY NUMBER:
136610561
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/08/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Janet Hernandez, ApplicantTIME COMPLETED:
11:55 AM
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On September 8, 2021 at 10:20 AM, Licensing Program Analyst (LPA), Marie Hernandez conducted an announced Pre-licensing and RAST Inspection due to the COVID -19 State of Emergency with the Applicant, Janet Hernandez. The purpose of the inspection is to ensure the home is incompliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This is a one story four bedroom and two bath home. The hours of operation are Monday through Sunday from 6:00 AM to 5:55 AM. LPA toured and inspected the home. The Applicant will use the following areas for childcare: The kitchen, living room, dining room, bedroom #1, hallway bathroom and the enclosed backyard. The off-limit areas are master bedroom #2 with the attached bathroom, bedroom #3, bedroom #4 and the laundry room. The off limit areas are inaccessible to children through the use of a child proof doorknobs and child proof safety gate. The Applicant was advised that when the children are outside, full supervision must be at all times. There are no bodies of water in the home. The fire extinguisher meets the requirement. The required smoke detector and carbon monoxide detector are operational. All poisons, detergents, cleaning compounds and medicines are secured, inaccessible and out of reach of children. Age appropriate toys and play equipment are available. A working telephone is available. The Applicant indicated that there are no weapons in the home. The Applicant maintains documentation of proof of control of property for review by the Department. The Applicant's Mandated Reporter AB1207 online training expires on 01/25/2023. The mandated reporter certification must be renewed every two years prior to expiration. The Applicant has completed the 8 hours of preventative health certification. The pediatric CPR and First Aid certification expires 01/2023. The required documents are posted. The Applicant and the adult residents have the criminal record clearances on file. The Applicant was advised that any new/additional adults must be cleared prior to working or residing in the home. Any minor upon their 18th birthday must be fingerprinted within 30 days. Immunization records per SB792 were reviewed and are incompliance. LPA advised that prior to making alterations or additions to the home or grounds, the Applicant shall notify the Department of the proposed changes. The Applicants states they are financially secure to operate a family childcare home for children and will comply with all regulations and laws governing family childcare homes.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HERNANDEZ, JANET FAMILY CHILD CARE
FACILITY NUMBER: 136610561
VISIT DATE: 09/08/2021
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The Applicant does not plan on providing Incidental Medical Services (IMS) to children at this time. 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. Megan’s Law was discussed www.meganslaw.ca.gov.

A New Provider Resource Packet was reviewed with the Applicant including information on the following: Safe Sleep, SIDS, shaken baby, child abuse reporting, community resources, YMCA Childcare Resource Service, children’s records, facility records, required postings, immunization's, unusual incident report, facility roster, car seat law, visual for ratio/capacity, fire/disaster drill log and prohibited items including no smoking or corporal punishment in a day care. LPA discussed the maximum capacity for a small family child care home: Maximum capacity: 6 - no more than 3 infants or 4 infants only. Capacity of 8 - No more than two infants, 1 child in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the home. Discussed and provided the Covid-19 postings. LPA discussed the Guardian for background checks and disassociation's with the Applicant.

The Applicant is advised to regularly visit the Community Care Licensing WEBSITE:www.cdss.ca.gov for quarterly updates and updated regulation information. The Duty Line was provided: (619) 767-2248. Southern California Child Care Advocate information was provided, and the Applicant was encouraged to subscribe through the CCLD website in order to be placed on an email list for updated regulation information. The Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

The Applicant is ready for licensure effective today, September 8, 2021. LPA Marie Hernandez explained the inspection report, and the Applicant stated it was understood. An exit interview was conducted, and a copy of the report was provided to the Applicant.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
LIC809 (FAS) - (06/04)
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