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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700450
Report Date: 09/27/2022
Date Signed: 09/27/2022 03:28:12 PM

Document Has Been Signed on 09/27/2022 03:28 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:FERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
197700450
ADMINISTRATOR:BLANCA FERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 964-7262
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Blanca FernandezTIME COMPLETED:
03:40 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 09/27/22, Licensing Program Analysts (LPAs) Justeene Tamayo and Andrew Alemoh met with assistant #1 (minor) , who guided analyst on a tour of the facility for the One Year Required inspection. This is a one story, 3 bedroom, 2.5 bathroom home with kitchen/dining, living room, laundry room and garage. There is no pool/spa or body of water on the premises. Upon arrival LPAs observed 4 preschool children in care. Licensee Blanca Fernandez later came with 4 more school age children. Licensee left 4 enrolled day care children alone with a minor (assistant #1) while licensee was picking up day care children from school. This poses an immediate risk to day care children. Facility has been cited a Type A citation. Please see LIC809-D. A civil penalty of $500 dollars has been assessed. LIC9224 given to licensee during the visit.***Upon receipt of the Type A Violation(s), licensee shall post the report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility by the close of business the following day or the next day child returns to the facility. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file.

Family members residing in the home include 1 adult (licensee) and 2 minor children. Facility operation are Monday-Friday 6AM-6PM. Incidental Medical Services (IMS) policy was discussed.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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 5
Document Has Been Signed on 09/27/2022 03:28 PM - It Cannot Be Edited


Created By: Justeene Tamayo On 09/27/2022 at 02:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type A
Section Cited
CCR
102417(a)
Operation of A Family Child Care Home
(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation,interview, record review, the licensee did not comply with the section cited above. LPAs observed a 17 year old (minor) left unattended with 4 day care children without the licensee present in the facility, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2022
Plan of Correction
1
2
3
4
Licensee will ensure she does not leave the day care children with a minor while she picks up other day care children from school. Licensee arrived to the facility within 30 minutes of LPAs entering the facility.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022


LIC809 (FAS) - (06/04)
Page: 5 of 5
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450
VISIT DATE: 09/27/2022
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
Physical Plant: Main care is provided in the family room and living room. Children use the bathroom in hallway on the left. Children have access to the living room and family room. Off limit areas include all bedrooms, bathroom #1.5, kitchen, laundry room, and garage. LPAs observed a barricaded gate in the hallway making all bedrooms, bathroom #1.5, laundry room, and garage inaccessible to children in care. LPAs also observed two safety gates on each side of the kitchen entrances to be barricaded. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (in laundry room area and under kitchen sink with safety latch), medicines (upper kitchen cabinet with safety latch) and hazardous items (sharp knives in upper kitchen cabinet with safety latch) that can pose a danger to children. LPAs observed the fireplace to be screened. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector, Fire Extinguisher (3A40BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in the living room. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (landline and cell).

Last Fire/Disaster Drill is maintained current. Last Fire/Disaster drill was completed on 07/06/22.

Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPAs did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450
VISIT DATE: 09/27/2022
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
Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in laundry room (off limit) and under kitchen sink (off limit with safety latch). Licensee provides breakfast,lunch,snacks, and dinner. Naps are provided on cots in the family room.

Outdoor: The backyard is safe for children. The backyard is completely fenced. There is no body of water. LPAs observed age appropriate toys. LPAs observed a chain link fence barricading two storage sheds and an outdoor air conditioner. There is currently one dog on the premises.

CPR/First Aid are current. CPR/First Aid expires on 02/04/2024. Mandated Reporter expires on 10/20/2022. LPAs reminded licensee, mandated reporter training must be completed every two years. There are no window cords accessible to children. Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), and Emergency Disaster Plan. Licensee stated currently has child care insurance.

Licensee Fernandez 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.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450
VISIT DATE: 09/27/2022
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
LPAs discussed the safe sleep regulations with licensee Fernandez 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. LPAs 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 to licensee and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with licensee Blanca Fernandez, along with her appeal rights and notice of site visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5