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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313565
Report Date: 11/17/2022
Date Signed: 12/14/2022 08:01:30 AM

Document Has Been Signed on 12/14/2022 08:01 AM - 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:HERNANDEZ-GARCIA, ALBAFACILITY NUMBER:
304313565
ADMINISTRATOR:HERNANDEZ-GARCIA, ALBAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 929-5994
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
11/17/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Alba Hernandez-GarciaTIME COMPLETED:
03:00 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
An informal Virtual office meeting was conducted on this date, 11/17/22, with Licensee, Alba Hernandez-Garcia . In attendance was Licensing Program Manager (LPM) Patricia Magana and Licensing Program Analyst (LPA)Patricia Rivas and Licensee Alba Hernandez-Garcia.

The purpose of the informal meeting was to discuss the following items:

102370 Criminal Record Clearance
Type ‘A’ deficiencies: (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record Exemption as required by the Department. On 03/10/22 LPA observed an uncleared assistant working in facility
102416.2(b)3(C)Reporting Requirements-Licensee failed to report an unusual incident. On 03/10/22 LPA observed that licensee failed to report when police made a visit

102423(a)3 and 4 Personal Rights -Children are to be treated with dignity in relationship with staff and other persons. On 05/24/22 LPA substantiated allegation that licensee handles children in an appropriate manner. LPA found that licensee had pulled on children's shirts. LPA found that licensee had forced a child to eat food by catching the food with spoon under chin and shoving food in mouth.

Type B deficiencies;
102425(b) INFANT SAFE SLEEP Cribs or play yards shall be free from all loose articles and objects. On 03/10/22 LPA Rivas observed a loose blanket in crib while child was sleeping,
102425((j) INFANT SAFE SLEEPhe provider shall physically check on the infant every 15 minutes. The provider shall check and document the following:Labored breathing.Signs of distres On 03/10/22 LPA Rivas observed documentation not complete; assistants reported licensee would fill iform out later; blank forms in filer

continued on page 2
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HERNANDEZ-GARCIA, ALBA
FACILITY NUMBER: 304313565
VISIT DATE: 11/17/2022
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
Page 2
Licensing Program Manager Patricia Magana discussed: Criminal Record Clearances requirements, Safe Sleep Regulations and Personal Rights. During the meeting LPA discussed Provider Information Notices (PIN) and Care Provider Meetings.

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
Lead exposure information, Pamphlet was provided to the Facility Representative.

**The facility representatives state that they will review the Department's Child Care Video Series at https://ccld.childcarevideos.org/ which will assist with increasing their understanding of the Department’s role in protecting the health and safety of children. The facility representatives will check the Department’s website https://www.cdss.ca.gov/inforesources/child-care-licensing for any updates on a quarterly basis and ensure compliance with California Code Title 22 Regulations.

LPM explained Technical Support Program (TSP), licensee stated she would like to receive services. LPA Rivas will provide information to LPM Lopez for referral.

LPA Rivas sent copy of LIC 624b (SP) via email .
LPA Rivas sent copy of PIN 22-29 CCP Child Care Licensing Webinars -Spanish Translation.

An exit interview was conducted, Report emailed.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2