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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844818
Report Date: 12/23/2021
Date Signed: 12/23/2021 03:34:35 PM

Document Has Been Signed on 12/23/2021 03:34 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
334844818
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
12/23/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Patricia Hernandez, LicenseeTIME COMPLETED:
03:40 PM
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Licensing Program Analysts (LPAs) Linda Almaraz and Nasha King, arrived for pending Plan of Correction (POCs), issued on 12/13/2021 during an annual visit and 12/09/2021 for a complaint. LPAs met with Patricia Hernandez, Licensee toured the facility and took census.

The following POCs were cleared for the following deficiencies during this inspection:
  1. 102416.5(c) -(c) The total licensed capacity for a Small Family Child Care Home shall not exceed eight children.
  2. 102417(g) -(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to..
  3. 102417(g)(9)(A) - (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.
  4. 1597.622(a)(1)- (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
  5. 102417(g)(7)- (7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
  6. 102418(a) - (a) Prior to admission to a family day care home, children shall be immunized against diseases a required by the California Code of Regulations, Title 17, beginning with Section 6000.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Linda M Almaraz
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2021
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 334844818
VISIT DATE: 12/23/2021
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7. 102421(b)-(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7).


8. 102417(g)(8)- (8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

9. 102419(d)(1)-(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

10. 102368(b) - (b)The license shall not be transferred to other individuals or locations.

All were cleared during this inspection, exit interview conducted, a copy of this report was provided to the Licensee. Report must be available upon request for public review for 3 years.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Linda M Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
LIC809 (FAS) - (06/04)
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