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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313565
Report Date: 03/10/2022
Date Signed: 03/10/2022 04:11:50 PM

Document Has Been Signed on 03/10/2022 04:11 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, 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: 9DATE:
03/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Alba Hernandez-Garcia, LicenseeTIME COMPLETED:
04:30 PM
NARRATIVE
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LIcensing Program Analysts, Patricia Rivas and Patricia Duron conducted an unannounced case management visit as a result of observations made during a facility walk though visit. LPAs were initially assisted by two assistance present in the home staff1 and staff2(S1 & S2). Licensee, Hernandez-Garcia arrived at 11:33am.

A facility walk through was conducted at 11:13 am. LPAs noted two children (C2 & C3) sleeping in play yards, both children had a loose blanket over them. LPA requested documentation for the 15 minute observation and were shown a blank long. Staff1(S1) stated that the staff tell licensee Ms. Alba Hernandez-Garcia and she fills it out. LPAs were advised that C2 was placed to sleep at 10:45 am. At 11:15am there was no documentation showing 15 minute checks.

LPAs requested child roster, Licensee stated at 11:40 that she did not include C3 name because child is on a probationary period.

Ms. Hernandez-Garcia stated she did not report the incident because the investigation was not concluded and the father of child 1(C1) had not been contacted by Police. LPA was advised by licensee she has over 4 years experience as a licensed childcare provider. LPA Rivas reminded licensee of requirement.
During the course of the investigation LPA was advised that staff 3 (S3) had worked at facility on 03/02/22, 03/03/22 and 03/04/22 and did provide care and supervision of children. At approximately 11:45 am S1 confirmed licensee's statement. LPA was advised by licensee that she has no file for S3 believes S3 took file.

The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: Criminal Record Clearances102370(d), Personnel Records 102416.1(a), Operation of a Family Child Care Home 102417(g)(8) , Infant Safe Sleep 102425(b) and j (1&2), (see LIC 809D).
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HERNANDEZ-GARCIA, ALBA
FACILITY NUMBER: 304313565
VISIT DATE: 03/10/2022
NARRATIVE
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LPAs left facility at 12:05 and returned at 2:42 pm. LPAs went to type reports out of facility since children were getting ready to eat.

Civil penalties issued for Criminal Records

Due to the Type A violations cited today, the licensee shall post, and provide copies, of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days.

---An exit interview conducted with Alba Hernandez-Garcia, licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

End of Report.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 03/10/2022 04:11 PM - It Cannot Be Edited


Created By: Pat Rivas On 03/10/2022 at 01:51 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: HERNANDEZ-GARCIA, ALBA
FACILITY NUMBER: 304313565

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/11/2022
Section Cited
CCR
102370(d)

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Criminal Record Clearance
Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review shall:Obtain a California clearance or a criminal record exemption as required by law or Department regulations . This requirement was not met as evidenced by;
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Licensee will not have any staff provide care and supervision to children in care without criminal record clearances and will not have adult live in facility without criminal record clearances. Licensee will review regulations and provide certification she understands and wiill following regulations and submit to LPA
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Licensee statement at 11:45 that Staff Maria Guadalupe Salas worked on 03/02/22, 03/03/22 and 03/04/22 and did not have fingerprint clearances. LPAs observation of no file in facility. This poses an immediate health and safety risk to children in care.
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Rivas by plan of correction date.
Type B
03/18/2022
Section Cited
CCR102416.1(a)

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Personnel Records
Personnel records shall be maintained on each employee . This requirement was not met as evidenced by Licensee's statement that she does not have a file for Staff #3. This poses a potential health and safety risk to children in care.
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licensee will review regulation , will provide certification that she undertands and submit to LPA by plan of correction date
Type B
03/18/2022
Section Cited
CCR
102417(g)8

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Operation of a Family Child Care Home
Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. Requirement not met by; Licensee stated that roster did not have C1 listed. LPA observed C1's name not to be on roster, this poses a potential threat to children in care.
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Licensee will update roster to include all children, "probationary" or not for whom she is providing care and supervision. licensee to provide LPA a copy of a current and complete roster by plan of correction date.
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:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/10/2022 04:11 PM - It Cannot Be Edited


Created By: Pat Rivas On 03/10/2022 at 02:07 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: HERNANDEZ-GARCIA, ALBA
FACILITY NUMBER: 304313565

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/18/2022
Section Cited
CCR
102425(b)

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INFANT SAFE SLEEP
Cribs or play yards shall be free from all loose articles and objects.. This requirement was not met as evidenced by; LPas observation of a loose blanket on C2. This is a potentital health and safety hazard to children in care.
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licensee will review a and have staff trained on safe sleep requirements, review CCL training modules and provide certification that licensee and stafff completed training ; certification to be sent to LPA by plan of correction date
Type B
03/18/2022
Section Cited
CCR
102425(j)(1-2)

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INFANT SAFE SLEEP
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes. The provider shall check and document the following:Labored breathing.Signs of distress,Infants up to 12 month of age
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licensee will adhere to regulations and have person who observes infant sleep document observations every 15 minutes. Licensee to train staff and provide copy of training and provide log for 2 days to LPA orrection
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 who are sleeping in a position other than on their back. Documentation shall be maintained in the infant’s file and be available to the Department for review.This requirement was not met as evidenced by a blank form, and S1's statement that they tell licensee and she fills it out.
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Type B
03/11/2022
Section Cited
CCR
102416.2(b)3(C)

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Reporting Requirements
The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home."A report shall be made to the Department…following the occurrence during the operation of a family day care home of any of the following events:Any unusual incident LIcensee did not report police involvement due to an allegation of abuse
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licensee to provide call Regional Office to make verbal report to on duty worker and written report to LPA Rivas by plan of correction date
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:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022


LIC809 (FAS) - (06/04)
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