198004954-5-27-2022-54-CC-KCHE-CETUGB-20220527153405

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198004954
Report Date: 05/27/2022
Date Signed: 05/27/2022 03:34:25 PM

Document Has Been Signed on 05/27/2022 03:34 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	HERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	198004954
ADMINISTRATOR:	HERNANDEZ, SAHARA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 583-5711
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90001
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 11	CENSUS: 7	DATE:	05/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Sahara Hernandez, Licensee		TIME COMPLETED:	04:00 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	Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required – 1 Year inspection to the above facility on 05/27/2022 at 1:30 PM. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Sahara Hernandez, who guided the LPA on a tour of the facility. Adults in the home were discussed. Also present was Licensee's Assistant, who has criminal record clearance. There were seven day care children present during today’s inspection. Licensee states that there are currently eleven children enrolled. The children's roster was reviewed and is current. Per Licensee, the facility’s hours of operation are 24/7. Licensee understands that she cannot provide care for a child longer than 23 hours. LPA discussed overnight care requirements with Licensee. Licensee states children will use standard cots for sleeping and stay in back daycare space. LPA observed standard cots stored in back daycare space. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 03/14/2022. This is a single-story home which consists of two bedrooms and two bathrooms, kitchen, and daycare space. Facility is front unit of duplex property, back house address is 1551 1/2 E. 76th St. Areas used by the children include daycare space (located upon entry of the home stretching to the back of home), Kitchen (located to the right upon entry), and Bathroom 1 (located down hallway through front daycare space). Per Licensee, areas off limits to children and parents include Bedroom 1 and Bedroom 2 with Bathroom 2. LPA observed Bedroom 2 storing three playpens, per Licensee this room only stores playpens but are moved to back daycare space when being used. Per Licensee, off limit areas are closed and locked during operating hours, LPA observed doors to be locked. Report Continues - Page 1 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198004954
	VISIT DATE: 05/27/2022

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All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed A/C wall units through out home. There is a working telephone maintained in the home. At 1:32 PM, LPA observed child size tables and chairs in front daycare space, books, and art materials that are well maintained available for children in care. At 1:34 PM, LPA observed back daycare space to have child size tables and chairs well maintained, cubbies for children's belongings, shelves filled with plastic manipulative toys, magnatiles, puzzles, soft play toys, puppets, and age appropriate toys, free of loose and sharp parts available for children at time of inspection. At 1:37 PM, LPA observed Kitchen to have operable child safety locks on all low cabinets and drawers at time of inspection. At 1:39 PM, LPA observed Bathroom 1 to have operable toilet and sink, adequate handwashing supplies, under cabinet sink to be empty, and floor free of hazards at time of inspection. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. At 1:38 PM, LPA observed these items to be stored in corner Kitchen cabinet with operable child safety lock and knives to be stored on high cabinet in Kitchen at time of inspection. The Licensee states that there are no poisons in the home. Per Licensee, they provide food for children in care.

Per Licensee, the children will have access to backyard area for outdoor play. At 1:40 PM, LPA observed children have access to backyard through sliding glass door in back daycare space. LPA observed backyard is shaded with concrete and adequate perimeter fencing through-out the yard. At 1:41 PM, LPA observed plastic crawl tube, child size tables and chairs well mainained, plastic ride along cars, and other age appropriate toys free of loose and sharp parts available for the children at time of inspection.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises or observe any weapons/firearms at time of inspection. Per Licensee, there are no pets and LPA did not observe any pets.
Report Continues - Page 2 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

LIC809 (FAS) - (06/04)

Page: 2 of 9

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198004954
	VISIT DATE: 05/27/2022

NARRATIVE

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At 1:50 PM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with service tag dated 03/28/2022. At 2:00 PM, LPA observed dual smoke and carbon monoxide detectors is in operable condition at time of inspection. LPA observed First Aid kit on wall in front daycare space. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has taken the Mandated Reporter Training
—CPR Card valid until: 08/2022
—Mandated Reporter AB1207 Completed: 01/11/2021

The following were discussed:
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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
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 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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.
Report Continues - Page 3 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

LIC809 (FAS) - (06/04)

Page: 3 of 9

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198004954
	VISIT DATE: 05/27/2022

NARRATIVE

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LPA discussed the safe sleep regulations with 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 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.

LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed.

Senate Bill 792: this bill, commencing September 1, 2016, 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 visit.

Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Sahara Hernandez.

Report Ends - Page 4 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

LIC809 (FAS) - (06/04)

Page: 4 of 9

Document Has Been Signed on 05/27/2022 03:34 PM - It Cannot Be Edited

Created By: Katrina Chicote On 05/27/2022 at 02:56 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198004954
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review at 2:50 PM, LPA did not observe LIC700 (Emergency ID) for C3, C4, C5, and C6. This is a potential health, safety, and personal rights risk to children.
	POC Due Date: 06/01/2022
	Plan of Correction
1 2 3 4	Licensee states she will obtain records from parents and email to LPA at above date.

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:

Trevino Cochran

LICENSING EVALUATOR NAME:

Katrina Chicote

LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

LIC809 (FAS) - (06/04)

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