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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019934
Report Date: 08/01/2023
Date Signed: 08/01/2023 05:56:08 PM

Document Has Been Signed on 08/01/2023 05:56 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 CAREFACILITY NUMBER:
198019934
ADMINISTRATOR:MARIA HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 440-3286
CITY:DOWNEYSTATE: CAZIP CODE:
90240
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 11DATE:
08/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Maria HernandezTIME COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elka Chavez conducted an unannounced annual inspection to the above facility on 08/01/2023. LPA arrived at the facility at 2:35 PM and met with Licensee, Maria Hernandez who guided analyst on a tour of the facility. Entrance Checklist for Family Child Care Homes was provided to the licensee upon entry. There were 11 children present upon arrival. Hours of operation are Monday through Friday from 6:00 AM to 6:30 PM and Saturday's from 7:00 AM to 3:00 PM.

This is a single-story home which consists of 4 bedrooms, 2 bathrooms, kitchen/dining room/laundry area, living room, detached garage, front yard (not fenced) and backyard (fenced). Areas accessible to children are: 2 front bedrooms, bathroom next to the bedroom hallway, living room, kitchen/dining room/laundry area and backyard (fenced). Areas off limits to children and parents are: two bedrooms toward the back of the home (locked), detached garage and pool. LPA observed a barricaded fireplace in the living room and dining room. During today’s inspection, Licensee asked to include the kitchen/dining room/laundry area as areas accessible to children in care. All off-limit areas need to be made inaccessible to children in care. The licensee understands that licensing staff may have access to off-limit areas during inspection visits if necessary. Food is provided by Licensee.

Individuals residing in the home have been discussed and noted. LPA did not observed staff #2 to be associated to the facility. LPA observed LIC 9163 form dated 7/20/18 on file. Licensee stated that she may have removed staff #2 from the facility roster in error.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and LIC 999A Facility Sketch or equivalent sketch. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 6/09/2023.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2023
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 5
Document Has Been Signed on 08/01/2023 05:56 PM - It Cannot Be Edited


Created By: Elka Chavez On 08/01/2023 at 05:03 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: 198019934

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA did not observe staff #2 to be associated to facility which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2023
Plan of Correction
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Licensee will call Guardian and will appeal difficiency.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA did not observe proof of immunization for C8 & C11 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/08/2023
Plan of Correction
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LIcensee stated that she will request paperwork prior to starting daycare.
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:Karen Chambers
LICENSING EVALUATOR NAME:Elka Chavez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 08/01/2023 05:56 PM - It Cannot Be Edited


Created By: Elka Chavez On 08/01/2023 at 05:03 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: 198019934

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA did not observe C8 & C11 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/08/2023
Plan of Correction
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LIcensee stated that she will request paperwork prior to starting daycare.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Karen Chambers
LICENSING EVALUATOR NAME:Elka Chavez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023


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: 198019934
VISIT DATE: 08/01/2023
NARRATIVE
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At 3:45 PM smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced in June 2023. The home maintains telephone service via cell phone. The home is observed to be clean and orderly. There are toys and other age-appropriate material available for children. LPA observed stairs leading to the backyard are screened to prevent access by children. LPA observed that detergents and cleaning compounds are kept in the garage and are inaccessible to children. Licensee understands that all poisons must be locked. LPA advised that if a child shows signs of illness, he/she/they shall be separated from other children. Per Licensee there are no firearms or weapons stored in the home.

Licensee cares for one infant. LPA observed play yard visible in living room and bedroom. Napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets. Each infant has their own play yard and bedding. Bedding is washed weekly or as needed by the Licensee. Licensee does not provide any overnight care at this time.

Currently, children are using the backyard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. LPA observed the pool is surrounded by an iron fence. LPA observed the fence to be in good repair. Fence is constructed so that it does not obscure the pool from view. LPA observed the fence to be at least 5 feet high, the bottom of the fence is no more than 4 inches from the ground and horizontal railings are at least 4 inches apart. The fence is constructed so that children are not able to climb it. LPA observed the gate swings away from the pool, self-closes and self-latches. The licensee states that supervision is always provided.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). LPA did not observe C8, C10 & C11 listed in the roster. LPA did not observe proof of immunization and LIC 700 Identification and Emergency Information for C8 & C11.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC 508- Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
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: 198019934
VISIT DATE: 08/01/2023
NARRATIVE
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Report Child Abuse and current Mandated Reporter Training Certificate.

Licensee Maria Hernandez was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee Maria Hernandez and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee Maria Hernandez 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) 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 and safety.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Maria Hernandez.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
LIC809 (FAS) - (06/04)
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