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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624759
Report Date: 02/17/2023
Date Signed: 02/17/2023 11:32:52 AM

Document Has Been Signed on 02/17/2023 11:32 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:HERNANDEZ, ANNABELFACILITY NUMBER:
343624759
ADMINISTRATOR:HERNANDEZ, ANNABELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 759-0414
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/17/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Annabel HernandezTIME COMPLETED:
11:45 AM
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At 10:00 a.m. on Friday, February 17th, 2023, Licensing Program Analyst (LPA) Karyn Guerra met with Applicant, Annabel Hernandez, for the purpose of an announced prelicensing change of location inspection. Applicant is currently licensed at facility number 343623025. Licensee’s assistant was also present during today’s inspection. Hours of operation are 6:00 a.m. - 6:00 p.m., Monday thru Friday.

A criminal record clearance is still needed for one adult living in the home. Applicant was reminded that all adults 18 and over living or working in the home, 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.

Applicant guided LPA on a tour of the facility. The two story home consists of 5 bedrooms, 7 bathrooms, kitchen and living room, butler's quarters, garage, and front, middle and back yards. Off-limit areas consists of the entire main house and front and backyard space. Child care will be in the butler's quarters and fenced middle yard spaces. Applicant acknowledges that child care children must never enter the off-limits area. LPA observed functioning smoke and carbon monoxide detectors, and a 2A10-BC fire extinguisher. LPA reviewed the required postings. Cleaning materials, hazardous items, and medications are all stored inaccessible to children. There is a pool and hot tub in the off limits backyard space. LPA did not observe fencing surrounding the bodies of water, nor a cover. Applicant stated that there are no weapons nor poisons in the home.

report continued on 809-C.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: HERNANDEZ, ANNABEL
FACILITY NUMBER: 343624759
VISIT DATE: 02/17/2023
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Proof of control of property was provided and consent from the homeowner has been granted to conduct child care in the home. Applicant has completed the required Preventative Health and Safety course. Applicant's current in person EMSA approved CPR and First Aid certification was verified and expires April 2023. Applicant was reminded that CPR/First Aid certification shall be renewed every two years. Mandated reporter training was verified for all staff.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

The following corrections are needed prior to licensure:

1. There shall be criminal record clearance for all adults in the home.

2. Pool and hot tub shall be made inaccessible either with fencing or cover that meets title 22 regulations.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC809 (FAS) - (06/04)
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