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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495062
Report Date: 05/17/2022
Date Signed: 05/17/2022 11:25:38 AM

Document Has Been Signed on 05/17/2022 11:25 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
197495062
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/17/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:02 AM
MET WITH:Lesly Hernandez- ApplicantTIME COMPLETED:
11:35 AM
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On 5/17/2022 at 8:02am, Licensing Program Analyst (LPA) Suzette Ornelas conducted an announced Pre-Licensing Inspection at 15504 Cimarron Ave, Gardena CA 90249. The purpose of the meeting was to ensure that health, safety and personal rights as required by Title 22 Regulations governing California Family Child Care homes will be met by the Applicant. This is an application for a Small Family Child Care Home, 8 children-ages 5 months to 10 years of age. The family child care home will operate Monday through Friday 7:00 a.m. to 5:30 p.m. LPA met with Applicant, Lesly Hernandez, who guided LPA on a tour of the inside and outside of the home. LPAs observed 3 adults and 0 child in care.

Per facility sketch and tour of the home, the following was observed and discussed with the Applicant during the inspection:


Home is a 1 story dwelling with 3 bedrooms and 2 bathrooms. The home consists of one living room, one kitchen and one laundry room. The home has locked gates on both sides of the home leading to the backyard. LPAs observed the following:

· The living room area is on- limits and will be used for childcare activities and napping. Electrical outlets have safety covers installed. Toys are age appropriate. TV is safely strapped to the wall.
· The kitchen is off limits and is made inaccessible from the living room area by a baby gate and from the laundry room by a baby gate. This room is equipped with one working dual carbon monoxide/smoke detector, as tested by the Applicant. Kitchen cabinet and drawers containing hazardous materials and sharp objects are made inaccessible by safety latches.
· Bathroom one is on limits to children in care and located on the right side of the hallway.
· Bathroom two is on limits to the children in care and located on the left side of the hallway near the laundry room.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197495062
VISIT DATE: 05/17/2022
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· Laundry room is on limits and will be used when leading children to the backyard. All detergents are enclosed in the cabinets with safety latched and are inaccessible to children in care.
· Master Bedroom is off limits and will not be used for children in care. Door will remain closed and has safety knob cover that will make the room inaccessible to children in care.
· Bedroom 1 is on limits and contains 2 play yards and a changing table. There is a closet containing children’s toys. There is one other pack and play kept stored in the backyard storage shed to use as needed.
· Bedroom 2 is off limits and will not be used for children in care. Door will remain closed with lock and key making the room inaccessible to children in care.
· Backyard is accessed through the laundry room. Storage bin contents are inaccessible to children in care.
· Front yard which is on limits when children enter the home. The front yard will not be used as a play area.
· Garage is off limits and inaccessible to children in care by a lock and a gate. Per applicant, landlord did not provide her with access to the garage; therefore, LPA was unable to visually inspect the area.

The following was also observed by LPAs during the inspection:
1. All adults living in the home have submitted fingerprints and child abuse index check forms to Department of Justice.
2. Home is neat and clean.
3. Home does not have a fireplace.

4. Home is equipped with a fully charged fire extinguisher which is at least a 2A:10BC.

5. Home is equipped with at least 1 working smoke alarm and a carbon monoxide detector.


6. Home has a working telephone.
7. All poisons, detergents, cleaning compounds, medications, etc. are inaccessible to children or are locked.
8. Hazardous materials are inaccessible and kept out of the reach of children.
9. According to the Applicant, there are no weapons or firearms in the home. None were observed by the LPA.
10. Outdoor play area is free from defects or dangerous conditions.
11. Outdoor play area is fenced in.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197495062
VISIT DATE: 05/17/2022
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12. No bodies of water were observed during the inspection.
13. Toys and play items are safe, clean, and appropriate for the ages of the children.
14. Applicant agrees that baby-walkers, bouncers, jumpers, and similar items will not be used for children in care and are kept inaccessible.
15. The home is equipped with a first-aid kit equipped with, cleansing pads healing ointment, bandages, gauze, and a digital thermometer.
16. The home is equipped with an emergency preparedness backpack for 4 people. Applicant stated that upon enrollment parents will be required to provide a small emergency for the child.

The following was thoroughly discussed with the Applicant
· Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541.
Email Address: childcareadvocatesprogram@dss.ca.gov

· Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.

· Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197495062
VISIT DATE: 05/17/2022
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· Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility. (AB) 633

· Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation.

· The fire extinguisher type 2A-10BC must be services annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.



· A current roster of children enrolled must be maintained and available. 1596.841

· Applicant was reminded to report any unusual incidents or injuries to the Child Care Regional Office by telephone within 24 hours and in writing within 7 days.

· Mandatory Forms for the children’s files and provider’s files were discussed. Licensee was referred to LIC 311D: Records To Be Maintained At The Facility - Family Child Care Home.

· Applicant was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome) and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials19-02 CCP Safe Sleep Awareness Campaign

· Applicant was reminded that only children eating may be in highchairs and that car seats are utilized only for transportation.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197495062
VISIT DATE: 05/17/2022
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· Applicant was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. 1596.846(b)(c)

· Applicant was reminded that it is the licensee’s, as well as anyone who assists in providing care, responsibility to know the regulations. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates as they come out to stay informed of any changes or updates to statutes and regulations.



· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR& Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

· Due to the COVID-19 pandemic and local and state ordinances, licensee was directed to the CCLD.CA.GOV website for important updates and PINS. Licensee was directed to PIN 22-10-CCP.



Proof of corrections have been discussed with Applicant, including:

Applicant will provide a copy of the enrollment agreement that states that upon enrollment parents will be required to provide a small emergency backpack for the child in care.



· Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

· LPA discussed the safe sleep regulations with applicant 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 applicant, 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.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197495062
VISIT DATE: 05/17/2022
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· This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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

· 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: http://www.ada.gov/childqanda.htm



Exit interview conducted and report was reviewed with the applicant, Lesly Hernandez.

LPA reviewed with applicant, Lesly Hernandez the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.



Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant, Lesly Hernandez. The home is in substantial compliance and ready for licensure.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022
LIC809 (FAS) - (06/04)
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