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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846501
Report Date: 06/28/2024
Date Signed: 06/28/2024 01:34:17 PM

Document Has Been Signed on 06/28/2024 01:34 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
364846501
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
06/28/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:DELIA HERNANDEZTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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On the date and time listed, Licensing Program Analyst (LPA) Aman Lama arrived at the facility. Licensee has applied to increase her capacity to that of a Large Family Child Care Home (FCCH) from a Small FCCH. LPA toured the on-limits area of the home, reviewed records, and the following was observed and/or discussed with Licensee:
Normal days/hours of operation are: Monday-Friday 7am-5pm.
OFF LIMIT AREAS INCLUDE: Entire 2nd floor.
-There is a pool in the apartment complex, which is gated and locked and inaccessible to children in care. Applicant understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
- Licensee understands all guns, weapons and ammunition must be key-locked separately and made inaccessible per Title 22 regulations.
- Storage areas for poisons are observed to be inaccessible and stored behind key-locked area of the home.
- All hazardous items are inaccessible, this includes; detergents, cleaning compounds, medications, and other items.
- There is a properly barricaded fire place
- Appropriate fire extinguisher, smoke detector and carbon monoxide detector are present and were tested by the applicant during this inspection.
- Home is clean and orderly, with heating and ventilation for safety and comfort.
- A working telephone is present.
- Outdoor play areas are fenced, and in compliance with Title 22 Regulations.
- Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed. All individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 364846501
VISIT DATE: 06/28/2024
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Facility Records Review:
- Pediatric CPR and First Aid Card expires on 08/2024, AB 1207 Mandated Child Abuse Reporter Training expires: 11/2024, licensee was reminded to renew these every 2 years.
- Documentation of emergency disaster drills on file. Emergency disaster drill completed on 06/03/2024.
- Review of staff records contain proof staff are immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year or provide a statement denying the influenza vaccination.
- Incidental Medical Services (IMS) policy was discussed. Licensee doe not plan to provide medications.
- Licensee 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.
The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov
- The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
- The Duty Officer is available to answer questions Monday – Friday from 8:00am to 5:00pm at (951)782-4200.
-LPA discussed the safe sleep regulations with licensee 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. Licensee was reminded that 15-minute sleep logs should be on file for any infants 24 months or younger.
-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.
There are no corrections needed at this time. The application for a increase of capacity will be submitted for approval with a maximum capacity of 12 children, up to 14 with parent notification..A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Exit interview conducted and report was reviewed with the Licensee, Delia Hernandez.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
LIC809 (FAS) - (06/04)
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