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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020244
Report Date: 05/04/2023
Date Signed: 05/04/2023 02:55:47 PM


Document Has Been Signed on 05/04/2023 02:55 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:FERNANDO FAMILY CHILD CAREFACILITY NUMBER:
198020244
ADMINISTRATOR:SHAMILA & TERVINE FERNANDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 728-7251
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 12DATE:
05/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Licensees Shamila and Tervine FernandoTIME COMPLETED:
03:10 PM
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On 5/4/23 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection at the above facility. LPA met with the Licensees Shamila and Tervine Fernando. LPA informed Licensees of the purpose for the visit and provided Licensees with a copy of the facility entrance checklist (LIC 126) All residents living in the home were discussed and noted. Facility provides care to children ages 3 months 14 years old. The facility is open Monday to Friday 6AM to 6PM. Upon arrival there were 12 children present and the two Licensees were providing care. There was one additional adult with a valid criminal record clearance present. The facility was in compliance with capacity requirements for a Large Family Child Care Home. One child left at approximately 1:00 PM.
This is a one story, 3 bedroom, 2 bathroom home with a living room, kitchen, dining area, enclosed backyard, detached garage.
Per Licensee areas on limits to children are: One bedroom used as a daycare room, living room used as daycare activity space, one bathroom, a section of the kitchen for children's meals and a section of the backyard.
Per Licensee areas off limits to children are: Detached garage, two bedrooms, one bathroom and kitchen a section of backyard. LPA observed several safety gates located throughout the home separating on limit and off limit areas.
All areas that are accessible to children were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA observed required posted documentation at the entrance of the facility- Facility license, Publication (PUB) 394- Notification of Parent Rights. LPA observed a current facility roster LIC 9040 and a disaster drill log. Last documented drill was conducted on 1/25/23. There is an operable carbon monoxide detector and an operable smoke detector located in the kitchen. LPA observed a 2A10BC Fire Extinguisher in the kitchen which indicated full. Licensee provided proof of purchase of the fire extinguisher dated July 2022. The home maintains telephone service (cell phone and landline). Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023
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: FERNANDO FAMILY CHILD CARE
FACILITY NUMBER: 198020244
VISIT DATE: 05/04/2023
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There are toys and other age appropriate materials available for children in the children's activity room and the living room. Sharp objects, detergents and cleaning compounds are inaccessible. Knives, cleaning products and personal medicines are kept in the off limits kitchen. LPA observed safety gates blocking access located at both entrances of the kitchen. At this time, there are no children who require medication. Heating and ventilation was evaluated. There is central air and heating in the facility. LPA did not observe any wall heaters or fire places in the home. Children nap in the living room. LPA observed napping mats available for children.
The children use the restroom next to the kitchen.. LPA did not observe cleaning products or medicine in the restroom. Per Licensees, children use the backyard for outdoor play. LPA observed age appropriate toys for children in the backyard. LPA observed a section of the backyard separated by a safety gate. Per Licensee, this section and the detached garage are off limits to children. Per Licensee, Children are supervised while playing outside. Per Licensees, there are no poisons kept in the home. Licensees were advised that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the living room separated from other children in care. Per Licensees, there are no firearms or weapons stored in the home. LPA did not observe any pools or spas, or other bodies of water. There are no pets in the home.
Infant Care: Currently there are 3 infants over 12 months enrolled. LPA observed 3 play yards in the day care room. LPA did not observe any loose or hanging items in the play yards. Napping equipment does not block the entrances or exits. LPA discussed the following with Licensee: Licensee was advised Infants shall not be swaddled in care. Car seats shall not be used for sleeping. LPA discussed the new Safe sleep regulation, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months. Currently, Per Licensees, 15 minute sleep logs were kept for children up to 12 months. LPA advised Licensees, 15 minute sleep check shall be maintained for infants 0 to 24 months.
Overnight Care: There is no overnight care provided at the moment. LPA discussed the following: Licensee is aware that they must remain awake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
Children's records were reviewed. LPA verified that records contained (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
Staff records were reviewed: Licensee Shamila Fernando completed a pediatric first aid/cpr course issued by the American Heart Association (AHA) on 4/22/23. Licensee Tervine Fernando does not have a pediatric first aid/cpr course completed.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
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: FERNANDO FAMILY CHILD CARE
FACILITY NUMBER: 198020244
VISIT DATE: 05/04/2023
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Licensee currently has an AHA Basic Life Support first aid/cpr course completed on 3/16/22. Per Licensee they were not aware it was not the required course and an approved course will be taken. Both Licensees have completed the Mandated Reporter training on 1/19/2022 and both Licensees have proof of immunization to measles, pertussis and flu and have TB clearance.
Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
During inspection the child present was observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.
Licensee 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.
LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleephttps://www.cdss.ca.gov/inforesources/child-care-licensing/ public -information-and-resources/safe-sleep as an additional resource.
LPA 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.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
Exit interview conducted and report was reviewed with both Licensees. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
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