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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274416047
Report Date: 03/18/2022
Date Signed: 03/18/2022 02:33:11 PM

Document Has Been Signed on 03/18/2022 02:33 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:HERNANDEZ-RIOS, CARLAFACILITY NUMBER:
274416047
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
03/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Carla Hernandez-RiosTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an announced pre-licensing inspection to the home today. LPA met with Carla Hernandez-Rios, applicant, and explained the nature of today's inspection to her. Applicant and her spouse Carlos are the two adults residing in the two story home. Also in the home reside applicant's minor children ages 14, 9, and 4 years old, and an infant who is one month and a half old.
Days and hours of operation will be Monday to Sunday from 3:00 AM to 2:00 AM. Applicant understands that the children cannot stay in the home for more than 24 continue hours. Applicant has completed her Preventative Health and Safety Child Care Training on 4/22/21 and the additional lead poisoning training on 10/05/21. Applicant's pediatric CPR and First Aid certifications are current and will expire on 2/12/24. Applicant owns the home and a copy of the property tax bill is in file. Applicant states does not have liability insurance for a family child care home (FCCH) and will use the Affidavit regarding liability insurance for Childcare (form LIC 282).
LPA toured the indoor and outdoor areas of the home during today's inspection. LPA observed there is a barricaded wall heater in the home. LPA observed the home has barricaded stairs to access the second floor where two bedrooms and one bathroom are located. Off limit areas inside the home: The second floor, and in the first floor: one bedroom, the utility porch, and the attached garage. LPA observed applicant has a 3A40BC fire extinguisher and at least one working smoke detector. LPA observed the home has at least one working carbon monoxide detector. Off limits outdoor areas are: A locked storage located in the back yard. LPA observed there are not bodies of water. Applicant will use the back yard as playground for the children in care. LPA observed the back and side yards are fenced. LPA observed the home has a trampoline located in the back yard, applicant was instructed and understands the trampoline must be used according with the manufacturer instructions, and must be kept in proper working conditions. Applicant states that there are no weapons in the home. Applicant understands that cleaning products, toxic agents, medications, and sharp objects shall not be accessible to children.
********************* Report dated 3/18/22 continues in page 2 ***************
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HERNANDEZ-RIOS, CARLA
FACILITY NUMBER: 274416047
VISIT DATE: 03/18/2022
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Report dated 3/18/22 continues from page 1.
LPA observed the home has a barricaded fireplace located in the on limits living room area. LPA reminded applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes.
Forms of discipline applicant will use: Communication with children and redirection. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed applicant that fire/disaster drills must be practiced at least once every 6 months and documented. A Family Child Care Home packet with updated Licensing forms was provided to and reviewed with the applicant. Department website: www. ccld.ca.gov provided to applicant. Applicant has four minor children, three of them younger than 10 years old, applicant understands that children residing in the home count as part of the capacity until them reach the age of ten years old.
LPA discussed the requirements of AB 633 with the applicant. LPA also discussed "zero tolerance" related regulations with the applicant.
LPA observed proof of immunization for measles, pertussis and influenza are in file for applicant.
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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
Applicant has completed the required "mandated reporter" training AB1207 on 9/20/21 and applicant understands the training is mandatory for all the adults in contact with children, and to be renewed every two years. LPA referred the applicant to the training website: www.manatedreporterca.com for additional information on the online training.
A review of staff records on 3/16/22 indicates that all the adults residing in the home or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

**************************Report dated 3/18/22 continues on page 3**********************
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: HERNANDEZ-RIOS, CARLA
FACILITY NUMBER: 274416047
VISIT DATE: 03/18/2022
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Report dated 3/18/22 continues from page 2.

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 web page 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.

LPA reviewed with applicant, 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, Carla Hernandez-Rios.

LPA conducted an exit interview with the applicant in Spanish and advised her that a small FCCH license will be approved pending on the following: 1) Approval from a manager of the Licensing Department.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
LIC809 (FAS) - (06/04)
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