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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153910994
Report Date: 06/14/2021
Date Signed: 06/14/2021 01:47:44 PM

Document Has Been Signed on 06/14/2021 01:47 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:HERNANDEZ, PETRA FAMILY CHILD CAREFACILITY NUMBER:
153910994
ADMINISTRATOR:HERNANDEZ, PETRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 346-2707
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
06/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Johanna HernandezTIME COMPLETED:
02:00 PM
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On 6/14/21 Licensing Program Analyst, (LPA) Caroline Harris conducted an unannounced annual inspection. LPA met with helper, Johanna Hernandez. LPA conducted a tour of the home as shown on the facility sketches (LIC 999A) provided. The LPA observed all required licensing forms to be posted in a visible location for authorized representatives to view them. A census was taken and there were six day care children present. The LPA observed the licensee to have one dog. The dog is an outside dog. The licensee is aware of the safety of children around animals and takes responsibility for any action taken by her pets. The LPA observed inaccessible rooms to be off limits to children by the use of door knob spinners and baby gates. The backyard is not in use at this time. Licensee is aware that children are to be supervised when outside an unfenced play area. There are no swimming pools or other bodies of water on the premises. The accessible rooms are the living room and hall bathroom. The LPA observed safe toys and play equipment. There were no poisons observed on the premises accessible to children. Licensee is aware that poisons are required to be locked and inaccessible to children. Cleaning compounds, medications and other hazardous items were inaccessible to children. There are no firearms or ammunition present at this facility. There is no fireplace. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. The licensee has a complete first aid kit, including bandages, scissor, thermometer, gloves and a first aid manual. Stairs are barricaded when children under age 5 years old are present. There is a working telephone and the above telephone number was verified. Adequate supervision is being provided during this visit. Capacity as specified on the license is being maintained.

LPA reviewed five children’s files. All required licensing documents were observed in each of the children’s files, including a copy of the Family Child Care Home Notification of Parent's Rights (LIC 995A). Licensee also maintains documentation of immunizations for the children.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2021
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: HERNANDEZ, PETRA FAMILY CHILD CARE
FACILITY NUMBER: 153910994
VISIT DATE: 06/14/2021
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Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services.

Fire drills are conducted and documented with the date, time and how many children present, every six months. Licensee is aware that children are never to be left in parked vehicles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. Pediatric CPR/First Aid are current and expire on 8/19/21. Licensee also maintains documentation of immunizations against pertussis, measles or influenza for herself and staff. Days and hours of operation are 3:00 AM – 11:59 PM, seven days a week.

An exit interview was conducted with Johanna Hernandez. LPA reviewed the Mandated Child Abuse Reporter Training (AB 1207), which Ms. Hernandez completed on 12/26/20. It is required to be updated every two years. There are currently no infants in care. The LPA discussed the Community Care Licensing website: www.ccld.ca.gov. which provides access to Provider Information Notifications (PINS), Quarterly Updates that inform licensees of new legislation and regulations, training's, and Licensing forms and updated information. The licensee was also advised that it is her responsibility to stay current with regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited. A copy of this report was provided to the licensee and was reviewed. This report shall be made available to the public upon request. The LIC 9213 Notice Of Site Visit form is required to be posted for 30 days.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021
LIC809 (FAS) - (06/04)
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