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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566211693
Report Date: 05/15/2024
Date Signed: 05/15/2024 04:40:31 PM

Document Has Been Signed on 05/15/2024 04:40 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
566211693
ADMINISTRATOR/
DIRECTOR:		MAXIMA HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 796-1133
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 16DATE:
05/15/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Mavima HernandezTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On May 15, 2024 at 1:45 PM, Licensing Program Analyst (LPA) Laura Villanueva made an unannounced visit to conduct a Case Management-Deficiencies Inspection. LPA met with licensee, Maxima Hernandez and explained the purpose of the inspection. LPA and licensee toured the interior and exterior of the home. Licensee and assistant were caring for 16 children at the time of the inspection.

LPA observed a working fountain driving by the home. LPA had discussed regulations for bodies of water on 03/06/2024 licensee. Licensee asked husband to remove water in LPAs presence. The fountain has running water. LPA informed licensee that a type A violation will be issued for a body of water accessible to the children in care. LPA observed 16 children in care. When LPA asked how many children were present , licensee stated that she had 8 or 9 children. LPA counted 16 children sleeping in the living room and in the playroom. An infant was sleeping in a car seat, another sleeping in a stroller, one other sleeping in a bouncer, and in recalled hammock like devices. Infants were covered with blankets. LPA observed toxins accessible in the children's bathroom.

LPA requested child files for children present. Licensee has C1 and C2 files only. Children C3-C16 did not have files available. LPA requested last file drill. The last documented fire drill was on 09/06/2023. Child roster was not up to date with the children in care.

Today, Type A and Type B deficiencies are being cited under Title 22 Division 12 Appeal rights given. Civil penalty was assessed. Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Maxima Hernandez.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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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Document Has Been Signed on 05/15/2024 04:40 PM - It Cannot Be Edited


Created By: Laura Villanueva On 05/15/2024 at 02:41 PM
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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 566211693

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2024
Section Cited
CCR
102425(j)(2)(D)(c)

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Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check. This requirement was not met as evidenced by: Licensee does not have 15
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Licensee will come into the office for a meeting next week. An invitation will be sent with time and date.
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minute sleep checks for infants present. Licensee was issued a type B citacion on 02/08/2024 for not having 15 minute checks for infants in care. This poses a potential risk to children in care.
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Type B
05/15/2024
Section Cited
CCR102417(8)

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(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement was not met as evidenced by: Licensee does not have a n updated child care roster for children in care. Licensee
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Licensee will come into the office for a meeting next week. An invitation will be sent with time and date.
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was issued a technical violation 02/08/2024 for not having a child care roster available. This poses a potential risk to 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:George Mingle
LICENSING EVALUATOR NAME:Laura Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


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Document Has Been Signed on 05/15/2024 04:40 PM - It Cannot Be Edited


Created By: Laura Villanueva On 05/15/2024 at 03:12 PM
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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 566211693

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/15/2024
Section Cited
HSC
102417(g)(5)(A-B)

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Zero Tolerance) All pools, spas, hot tubs, fish ponds, or similar bodies of
water shall be made inaccessible to children by covering or fencing as
specified by regulation. This requirement was not met as evidenced by: There is a
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lLicensee will come into the office for a meeting next week. An invitation will be sent with time and date.
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working water fountain next to the front door. On 03/06/2024, LPA observed licensee's husband empty water out of fountain. Today, there was water in the working fountain agian. LPA spoke to licensee about zero tolerance for bodies of water. This requirement is an immediate risk to children in care.
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Type A
05/15/2024
Section Cited
HSC102416,5(a)

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102416.5 Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.This requirement was not met as evidenced by: Licensee and Assistant
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lLicensee will come into the office for a meeting next week. An invitation will be sent with time and date.
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were caring for 16 children. This poses an immediate risk to 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:George Mingle
LICENSING EVALUATOR NAME:Laura Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/15/2024 04:40 PM - It Cannot Be Edited


Created By: Laura Villanueva On 05/15/2024 at 03:25 PM
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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 566211693

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2024
Section Cited
CCR
102421(b)

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The licensee shall maintain, in each child's record, a copy of the emergency
information card that contains all of the information specified by regulation. This requirement was not met as evidenced by: Licensee did not have files for all children in
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Licensee will come into the office for a meeting next week. An invitation will be sent with time and date.
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care. there were only files for C1 & C2, This poses a potential risk to children in care.
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Type B
05/15/2024
Section Cited
CCR102417(g)(9)(A)(1)

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All homes shall conduct fire and disaster drills at least once every six months,
and document the date and time of each drill.nThis requirement was not met as evidenced by:The last fire drill was conducted on 09/06/2023. This poses a
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Licensee will come into the office for a meeting next week. An invitation will be sent with time and date.
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potential risk to 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:George Mingle
LICENSING EVALUATOR NAME:Laura Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/15/2024 04:40 PM - It Cannot Be Edited


Created By: Laura Villanueva On 05/15/2024 at 03:43 PM
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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 566211693

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/15/2024
Section Cited
HSC
102417(g)(10)

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:(10) A baby walker shall not be allowed on the premises of a family child care home in accordance with .
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Licensee will come into the office for a meeting next week. An invitation will be sent with time and date.
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Health and Safety Code Section 1596.846(b) and (c). This requirement was not met as evidenced by: Infants were sleeping in a car seat, a stroller, a recalled hammock bed. There was not enough cribs for infants in care. This poses an immediate risk to children in care.
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Licensee will come into the office for a meeting next week. An invitation will be sent with time and date.
Type A
05/15/2024
Section Cited
HSC102425(b)

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(b) Cribs or play yards shall be free from all loose articles and objects. This requirement was not met as evidenced by: LPA observed all infants covered with a blanket while sleeping.This poses an imediate threat to children in care.
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Licensee will come into the office for a meeting next week. An invitation will be sent with time and date.

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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:George Mingle
LICENSING EVALUATOR NAME:Laura Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/15/2024 04:40 PM - It Cannot Be Edited


Created By: Laura Villanueva On 05/15/2024 at 04:15 PM
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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 566211693

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/15/2024
Section Cited
HSC
102417(g)(4)(A)

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which pose a danger if
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readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked. This requirement was not met as eividenced by: LPA observed Glade, nasal spray, mouth wash accessible in the cabinets in the children's bathroom. This poses an immediate risk to 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:George Mingle
LICENSING EVALUATOR NAME:Laura Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
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