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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492985
Report Date: 08/15/2023
Date Signed: 08/15/2023 12:16:40 PM

Document Has Been Signed on 08/15/2023 12:16 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
197492985
ADMINISTRATOR:HERNANDEZ, DOLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 793-6987
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
08/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:29 AM
MET WITH:Dolores HernandezTIME COMPLETED:
12:45 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 8/17/2023, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Required 1-Year inspection at the Hernandez Family Child Care Home. Upon arrival, the LPA met with the licensee, Dolores Hernandez, who guided the LPA on a tour of the facility. Individuals that reside in the home include Family members residing, including the home include 2 adults (licensee, spouse), and two children. Pre Guardian, all adults in this facility obtain a criminal record clearance.
This is a large family childcare facility. The hours of operation are Monday through Sunday. 24 hours. During the inspection, LPA observed 6 childcare children (1 school-age, 4 preschools and 1 toddler) with Licensee and her assistant. Per Licensing Information System, annual facility fees were current. Incidental Medical Services (IMS) were discussed. Per the licensee, she does not have children who need IMS at this time.
The home is set up as follows: This is a two-story home with 3 bedrooms, 3 bathrooms, a kitchen, a living room, a dining room, , and a garage. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The house has central heating and air conditioning. All windows have screens and are free of cracks, bugs, and debris.
Main care is provided in the living room and dining room. The children use the bathroom located underneath the stairs to the left. The children also use the backyard for play.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
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 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197492985
VISIT DATE: 08/15/2023
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
Living Room and Dining Room: Age-appropriate toys and furniture were observed to be on the premises of this facility. All toys and furniture were observed to be in good condition during this inspection. TV electric wires are hanging on the wall.
Bathroom #1 (Children Bathroom): Children will use bathroom#1 located to the right of the Bedroom. Bathroom #1 was toured and inspected sink/toilet is in operable condition. Bathroom #1 is clean, safe, and operable; the bathtub and shower area are free of hazards. No medications storage in the medicine cabinet.
Kitchen: All sharp utensils and cutlery, cleaning supplies, medicines; drawers, and cabinets with plastic bags, and sharp things or small things children can swallow; are made inaccessible to children with child safety latches on the sink cabinet. The refrigerator dishwasher, stove, microwave, etc., are clean. The kitchen was clean, orderly, and free of hazardous items.
Backyard: The backyard was inspected; the backyard is clean and free from all debris. The backyard is fully fenced. There is a pool on the premises. The backyard is open and adequately fenced. A trampoline is on the premises and per the licensee school, aged children utilize the equipment for play under the direct supervision of the licensee. There is dog in the pool area. However, the children may be able to touch the dog. The licensee understands is her responsibility to make sure the children are supervised at all times.

The off-limits areas are all three bedrooms and the two restrooms located upstairs. (There is a child gate to make the second floor inaccessible to the children)


Other:
· AC/Heating Unit / Swamp Cooler unit was observed. The AC/Heating Unit is located on the right side of the home and is inaccessible to children via barrels blocking access to the AC unit.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC809 (FAS) - (06/04)
Page: 3 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197492985
VISIT DATE: 08/15/2023
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
· Bodies of water: Per the licensee, there are bodies of water in the home. LPA observed a pool in the backyard. The gate shall swing away from the pool, self-close, and have a self-latching device located more than six inches from the top of the gate. Fences are at least five feet high and should be constructed so that the fence does not obscure the pool from view. The bottom and sides of the fence shall comply with Division 1, Appendix Chapter 4 of the 1994 Uniform Building Code.
· Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
· Food: The licensee is enrolled in Food program. The licensee will provide Breakfast, lunch, and snacks. Or the food is brought from home. The containers were labeled with the children’s names and properly stored or refrigerated.
· Fire extinguisher (2A10BC): LPA observed a required fire extinguisher (2A10BC) reading in Green and located in the kitchen, inaccessible to children. It meets standards established by the State Fire Marshall.
· Fireplace: No fireplace in this facility
· Hanging window blind cords: The cords are accessible to children.
· Isolation area (Illness): Per the licensee, if the child shows signs of illness, they will be separated from other children and stay in the Living room.
· Medications and cleaning solutions: LPA observed cleaning compound was on the kitchen counter, accessible to the children. Medications are in the off-limits bedroom.
· Napping: Children will nap in designated areas with adult supervision. LPA observed 3 mats and 6 cots in the closet.
· Overnight Care: According to the licensee does not provide overnight care.
· Pets: The licensee has 1 dog and 2 cats. Both pets have current vaccination
· Phone service: There is a working landline or cell phone.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC809 (FAS) - (06/04)
Page: 4 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197492985
VISIT DATE: 08/15/2023
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
· Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested operable.
· The First Aid kit is in the key-locked closet, inaccessible to children. The First Aid Kit was observed to be complete with supplies and a first aid manual.
· Transportation: The licensee does provide transportation for children. The licensee has a valid California driver's license, valid vehicle insurance, and vehicle registration.
· Weapons or Firearms: Per the licensee, there are No Firearms at the facility at this time. LPA does not observe any firearms.
Documentation:
· Child files: LPA observed that 5 children's files contained all required licensing documents.
· CPR/First Aid: LPA observed licensee has current Pediatric CPR and First Aid Training with an expiration date (of 01/2024).
· Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and performed on 12/20/2022. OR no current facility earthquake/fire drill documents were observed during this inspection.
· Immunization: The licensee and her assistant have the required immunizations (MMR and DTaP). The licensee and her assistant provided a written statement declining the influenza vaccination.
· Infant Sleeping Plan (LIC 9227) and Sleeping Log: LPA shared the information with the licensee. Per the licensee, NO infant (0-12 months) is enrolled in the facility.
· The licensee (does not) post all required information
· Mandated Reporter Training: The licensee has completed and renewed the online mandated reporter training at www.mandatedreporterca.com on 5/12/2022
· Staff Personnel File: LPA observed 1 staff information. The file contained all required licensing documents
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC809 (FAS) - (06/04)
Page: 5 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197492985
VISIT DATE: 08/15/2023
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
The following information was discussed with the licensee:
Ø Mandatory Forms for the children's files and provider's files.
Ø The licensee is reminded that 100% supervision is required for children at all times.
Ø Capacity requirements, Roster requirements, and Documentation requirements for disaster drills (fire and earthquake).
Ø Licensee was made aware that it is their responsibility to know the regulations and anyone who assists in providing care. Licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility's phone number; if the phone number is changed, licensing must be notified.
Ø Licensee was advised of the requirement to report unusual incidents and injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
Ø The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
Ø Criminal Record Statement: The licensee [or facility representative] 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 support or exemption prior to the 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC809 (FAS) - (06/04)
Page: 6 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197492985
VISIT DATE: 08/15/2023
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
Ø Safe Sleep: LPA discussed the safe sleep regulations with the 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 the licensee [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.
Ø A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety code sections 1596.848(b) and (c). State law prohibits baby walkers, bouncy seats, exersaucer, and other items that fall into that category.
Ø Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.
Ø Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Ø The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban).
Ø Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations.
o Our Quarterly updates come out every 3 months. They are also now in Spanish. Please log in to the CCLD website, or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC809 (FAS) - (06/04)
Page: 7 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197492985
VISIT DATE: 08/15/2023
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
Ø The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.

No deficiency was cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.

An exit Interview was conducted, and a copy of this Report and a Notice of Site visit were provided to the licensee, Delores Hernandez.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC809 (FAS) - (06/04)
Page: 8 of 8