566216974-4-29-2024-17-CC-AZES-D4SP7R-20240429110423

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566216974
Report Date: 04/29/2024
Date Signed: 04/29/2024 11:04:36 AM

Document Has Been Signed on 04/29/2024 11:04 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	HERNANDEZ GARCIA FAMILY CHILD CARE		FACILITY NUMBER:	566216974
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS:	DATE:	04/29/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Gloria Hernandez		TIME VISIT/ INSPECTION COMPLETED:	11:18 AM

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This is a change of location. Old facility number is 566216532.

On April 29, 2024 at 9:30 AM, Licensing Program Analysts (LPAs) Susana Martinez and Aaliyah Zendejas conducted an announced inspection for the purpose of conducting a pre-licensing change of location visit at the above mentioned facility. LPAs Martinez and Zendejas met with licensee Gloria Hernandez, and discussed the purpose of the inspection. LPAs toured the interior and exterior of the home.

All adults in the home are fingerprint cleared. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

During this tour the following was noted:
Licensee applied for a change of location. Family members residing in the home are 2 adults, 1 child over the age of 18, and 2 children under the age of 18. Licensee stated that their hours of operation are from 5:00 AM to 5:00 PM Monday through Saturday. The ages of the children are from 0-13 years of age.

All areas identified on the facility sketch were inspected. This is a single-story home which consists of three

bedrooms, one restroom, living room, kitchen, fenced backyard, and an additional detached room. Licensee stated that the detached room will not be used for day care. LPAs advised that if it is used for care they will need a fire clearance and to let licensing know. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPAs toured backyard area and reminded licensee to lock up storage areas when children are in care so they do not have access to the storage and to put gates in the backyard where children do not belong. There were no bodies of water observed.

Con'd on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HERNANDEZ GARCIA FAMILY CHILD CARE	FACILITY NUMBER: 566216974
	VISIT DATE: 04/29/2024

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LPA observed a regulation 2A10BC fire extinguisher in the FCCH at the time of the inspection that was purchased on March 20, 2024 but did not have a receipt or service ticket. Licensee is reminded to service or purchase the fire extinguisher yearly. LPA observed applicant test both smoke and carbon monoxide detectors in the home at 9:37 AM and were functioning at the time of the inspection. Applicant stated that there are no weapons or ammunition in the home.

Applicant is current with immunization required per SB 792. Applicant completed the Orientation on December 28, 2021. Applicant Pediatric First Aid/CPR certificate is valid until August 9, 2025. Applicant completed the Preventative Health & Safety on August 28, 2021. Applicant’s Mandated Reporter Training certificate is valid until December 6, 2025 . The applicant, provided proof of control of property. Control of property was verified via receipt of lease agreement. Because the applicant, rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

On this date, April 29, 2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice

Off limit areas included: 4 bedrooms including the detached room, kitchen, and a small area in the backyard. LPA noted a child proof gate by the kitchen. LPA advised applicant to have children safety locks or a gate by on the bedroom doors making the bedrooms inaccessible to children.

LPA observed that no knives and medication in the facility, but advised applicant that they are to be stored in an elevated cabinet in the kitchen inaccessible to children. No cleaning compounds were observed, but licensee stated that when they fully move in they will have them in an out of reach area for children. The bathroom to be used for children in care was observed to be clean and free of toxins.

Con'd on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HERNANDEZ GARCIA FAMILY CHILD CARE	FACILITY NUMBER: 566216974
	VISIT DATE: 04/29/2024

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LPA observed the exits to be secured. LPA observed there is shading in the backyard area for the children in care. In addition, Filtered water will be accessible by means of individual water bottles. LPA and applicant discussed active supervision when children are in the outdoor yard.

· No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

· All adults living and working in the home shall be made of aware of the Department inspection rights authority.

(USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Forms to be posted
LIC6101A Emergency Disaster Plan,
PUB394 Notification of Parents Rights Poster,
Facility License

Facility Records: LIC 624B Unusual Incident/Injury Report, LIC 9040 Child Care Facility Roster, LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse,
Staff Forms/Records - any assistant present must have the following on file: Proof of TB clearance (within one year), Notice of Employee Rights (LIC 9052), Criminal Record Statement (LIC 508), Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9180).

Children ’s records requirements: LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children in Care, Immunization record, PUB 72- Family Child Care Consumer Guide, LIC 995A Notification of Parent’s Rights

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. Applicant was made aware the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

Con'd on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HERNANDEZ GARCIA FAMILY CHILD CARE	FACILITY NUMBER: 566216974
	VISIT DATE: 04/29/2024

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Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed Applicant 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 of infant devices or their purchased equipment.

The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Martinez.

License is pending due to the following items:

- Licensee needs to provide a receipt for the fire extinguisher or proof of service

-Licensee needs to have a gate in front of bedrooms or something to prevent children from entering bedrooms.

-Licensee needs to have the home fumigated

A notice of site visit was given to applicant and must remain posted on, or immediately

adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was
reviewed with the licensee Gloria Hernandez.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY. THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024

LIC809 (FAS) - (06/04)

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