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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100049
Report Date: 07/21/2021
Date Signed: 07/21/2021 11:13:31 AM

Document Has Been Signed on 07/21/2021 11:13 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HERNANDEZ ROBLES, FLOR FAMILY CHILD CAREFACILITY NUMBER:
376100049
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
07/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Flor Hernandez RoblesTIME COMPLETED:
11:20 AM
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(1) On 07/21/2021 at 9:15AM, Licensing Program Analyst (LPA) Selina Siao conducted an unannounced random and capacity increase inspection. The home was toured and inspected to ensure an environment safe for the care and supervision of children. Upon arrival at the facility were helper Paifang Hsiao and three day care infants including licensee's own child. Another day care infant was dropped off shortly. Licensee returned back to the facility within ten minutes during the inspection. The home has a fully charged fire extinguisher size 3A40BC, smoke and carbon monoxide detector that meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Licensee stated that there are no bodies of water or weapons in the home. 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 clearances valid through -01/23/2023 and Helper Paifang Hsiao has an EMSA approved CPR and First Aid certificates valid through 10/19/2021. Licensee's online mandated child abuse training had expired on 07/15/2021. Children’s records were reviewed and all records are in ordered, all infants under the age of 12 months also has the safe sleeping plan form completed by their parents. Facility has an updated roster and fire drill log available for review. Licensee last conducted a drill with the children in care on 06/17/2021.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include living room, dining room and one napping room. Licensee requested to add the kitchen for the children to use mainly to wash hand. Off limits areas include laundry room and master bedroom and master bath which are inaccessible through use of door knob cover. The facility has sufficient toys and equipment available. The home has a fence patio available for outdoor activities.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2021
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HERNANDEZ ROBLES, FLOR FAMILY CHILD CARE
FACILITY NUMBER: 376100049
VISIT DATE: 07/21/2021
NARRATIVE
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Licensee has the required proof of immunizations for Measles, Pertussis and Influenza requirement. Helper has the required Pertussis and influenza requirement.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The following items were discussed with provider: Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. Licensee will be provided with information about Heat Related Illness, Sudden Infant Death Syndrome (SIDS), Never Shake a Baby, safe sleep for infants, best practice on supervision, latest car seat poster and effects of lead exposure and reporting responsibilities were discussed. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website www.ccld.ca.gov to receive important updates. LPA discussed California Megan's Law with provider www.meganslaw.ca.gov.

Facility was approved for a large license by the San Diego Fire Department on 06/24/2021 and a large license will be granted effective today.

See LIC809D for deficiency:

A Notice of Site Visit was posted during the inspection and it must remain posted for a period or 30 days. Failure to keep notice posted will result in a civil penalty of $100.00. Provided appeal rights to licensee today.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/21/2021 11:13 AM - It Cannot Be Edited


Created By: Selina Siao On 07/21/2021 at 10:33 AM
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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: HERNANDEZ ROBLES, FLOR FAMILY CHILD CARE
FACILITY NUMBER: 376100049

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2021
Section Cited
CCR
102417(d)

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Operation of a Family Child Care Home: The home shall provide safe toys, play equipment and materials. This requirement is not met as evidence that LPA Siao observed a rocker chair in the dining room area accessible to children. This poses a potential health and safety risk to children in care.
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Licensee removed it to an off limit area during the inspection and said that she will be sure to not use it for children in care.

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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:Monica Cuddy
LICENSING EVALUATOR NAME:Selina Siao
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2021


LIC809 (FAS) - (06/04)
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