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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314094
Report Date: 06/08/2023
Date Signed: 06/08/2023 10:26:50 AM

Document Has Been Signed on 06/08/2023 10:26 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:BERNABE, KARINAFACILITY NUMBER:
304314094
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 0DATE:
06/08/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Karina Bernabe, LicenseeTIME COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Stacy Torrence conducted a case management inspection, in response to licensee’s request for a capacity increase. LPA met with licensee Karina Bernabe, who guided analyst on a tour of the facility. During today’s inspection, there were no children present. The facility was within licensed capacity and the required ratio. Licensee stated there is currently three adults and one minor child living in the home. Licensee stated she is not currently registered with any Foster Care agency or holds a foster parent license. Licensee was reminded if changes to notify the licensing office.

A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

This is a two-story home with four bedrooms, two and a half bathrooms, living room, family room, kitchen, dining room, front yard (not fence), backyard (fenced), and garage. The licensee has designated the living room, family room, one bathroom, dining room, and back yard, as part of the day-care. The licensee has designated the entire 2nd floor, kitchen, and garage, as off-limit areas. The licensee has a child proof safety gate, located at the bottom of the stairs. The licensee have child proof safety gates at both entrances of the kitchen, ensuring this area is inaccessible to the children in care. The garage has a lock and child proof doorknob on it. The licensee acknowledged the children may never enter the off-limit areas during operation hours. Control of property was verified by LPA during today’s inspection. The licensee has a cell phone that is used for childcare. The licensee was informed if a cell phone is used for childcare, it must always remain on the premises during hours of operation. Licensee was informed and understands the home is to be free from smoking during hours of operation.

The home has a fireplace, located in the family room; barricaded by a glass cover and screen. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Poisons/Hazardous items are not stored on site, and none were observed. There are no bodies of water. The toys are age appropriate and in good condition for the potential ages served. Baby walkers, bouncers, jumpers, and similar items will not be used for children in care. Licensee stated there are no weapons or firearms on the premises. When firearms are present, they must be locked and stored separately from the ammunition. During today's inspection, the smoke detector and carbon monoxide were operable, and the fire extinguisher was charged.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2023
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 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BERNABE, KARINA
FACILITY NUMBER: 304314094
VISIT DATE: 06/08/2023
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Licensee will use the backyard for children's outdoor activities. The back yard is appropriately fenced. LPA observed play equipment to be safe and free of hazards. There are no bodies of water on the premises.

Per licensee, parents provide food for the children. LPA reminded applicant, that if food is not provided and food is brought from the children’s homes; container shall be labeled with child’s name and properly stored or refrigerated.



Per licensee, all children will nap in the living room. Licensee stated parents will provide linen and blanket for the children.

Licensee’s Mandated Reporter Training were current. EMSA approved Pediatric CPR and Pediatric First Aid was current for licensee, which expires on 10/2023.

The licensee has a current roster of children in care. LPA reviewed the children’s records during LPA inspection and they were in compliance. The licensee has a current disaster drill log. LPA reviewed LIC 9227 Individual Infant Sleeping Plan forms one infant ages 0-12 months. LPA reviewed sleeping logs for all enrolled infants.



LPA advised the licensee how to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative 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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BERNABE, KARINA
FACILITY NUMBER: 304314094
VISIT DATE: 06/08/2023
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Licensee was reminded that all adults 18 and over, 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 Child Care Family 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.


Fire clearance granted on 05/30/2023.

During todays’ inspection, there were no deficiency cited and licensee was in compliance with California Code of Regulations Title 22 for operating a Family Child Care home.

A new license for operating a Large Family Child Care Home shall be issued upon final review and if additional information is needed, licensee shall be contacted.

An Inspection and exit interview were completed with licensee. The report was reviewed and discussed. Appeal Rights was discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) 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. Licensee was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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