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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409522
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:26:47 PM

Document Has Been Signed on 02/27/2024 02:26 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:HERNANDEZ, GLADYSFACILITY NUMBER:
073409522
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
02/27/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Gladys HernandezTIME COMPLETED:
02:40 PM
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On February 27, 2024 at 12:15pm, Licensing Program Analyst (LPA) Indira Loza arrived at the facility for an announced Change of Location inspection. LPA met with applicants Gladys Hernandez. Living in the home are the applicant and her three (3) minor children. The applicant plans to operate Monday-Saturday 5am - 10pm. LPA verified the Licensee's phone number and email on record are correct. LPA toured the home for a health and safety check. LPA observed that the home is neat and clean with heating and ventilation for the safety and comfort of children.

The home is a single family house. The home is one story and consists of a living room, kitchen, three bedrooms, one bathroom, one (1) car garage, fully fenced in front yard, and fully fenced in backyard.

The Off Limit Area is the kitchen, garage, and both bedrooms at the end of the hallway. The off limits areas will be made inaccessible by gate, closed and/or locked doors, and visual supervision.

The On Limit Areas are the living room, the bedroom next to the living room, bathroom, the front yard, the backyard, and the walkways on both sides of the house. The applicant was reminded to have 100% supervision of the children when playing outside. The Isolation Area will be the first bedroom next to the living room.

Inside the home the LPA observed an ample supply of age appropriate toys, activities and equipment for children, which appeared to be safe and in good condition. LPA did not observe any medication, bodies of water, hazardous items or poisons accessible to children during the inspection today. The applicant stated there are no firearms in the home.

The home is equipped with a fully charged 2A10BC fire extinguisher and working combined smoke detector and carbon monoxide detectors. The home also has a pull down fire alarm system. The applicant has a current CPR and First Aid certificate which expires on February 2026, and a current Mandated Reporter Certificate which expires on February 21, 2026. The applicant also has Liability Insurance which expires on February 16, 2025. The home has three (3) exits, one is the main entrance, the second is at the end of the


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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HERNANDEZ, GLADYS
FACILITY NUMBER: 073409522
VISIT DATE: 02/27/2024
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hallway to the backyard, and the third is through the garage. The applicant was reminded that the crib mattresses are to have fitted sheets made specifically for the mattress size being used for the infants.

LPA discussed the safe sleep regulations with the applicants and discussed the Child Care Licensing Safe Sleep webpage 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 on their purchased equipment.

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.



On February 27, 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 address. 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.

Applicants were 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child ******************************************************* Page 2 of 3 **********************************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HERNANDEZ, GLADYS
FACILITY NUMBER: 073409522
VISIT DATE: 02/27/2024
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Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

The applicant provided proof of control of the property. 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).


LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

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.

Before a License can be granted for a Family Child Care Home, the applicant must send the LPA a picture of fitted sheets on the crib. The sheet must be made specifically for the size of mattress on the portable crib, and must fit tightly with no wrinkles.

Exit interview conducted and report was reviewed with applicant Gladys Hernandez.
*******************************************************End of Report**********************************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC809 (FAS) - (06/04)
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