<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610591
Report Date: 08/04/2022
Date Signed: 08/04/2022 02:43:04 PM

Document Has Been Signed on 08/04/2022 02:43 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HERNANDEZ, ERIKA FAMILY CHILD CAREFACILITY NUMBER:
136610591
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 11CENSUS: 0DATE:
08/04/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Erika HernandezTIME COMPLETED:
02:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 08/04/2022, at 12:00 P.M. Licensing Program Analyst (LPA) Claudia Amador conducted an announced Change of Location inspection with the applicant, Erika Hernandez. The purpose of the inspection is to ensure the home complies with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This one-story, five-bedroom, four-bath home was toured and inspected. The hours of operation are Monday through Sunday, 12:00 a.m. – 11:59 p.m. The applicant is transitioning from a large license to a small license. The LPA provided the information required to apply for the large license.

The applicant will utilize the following areas for childcare: kitchen, living room, dining room, childcare room, and childcare bathroom. Off Limit areas include master bedroom, master bathroom, bedroom #1- bedroom #4 ( #4 with own bathroom), and hallway bathroom. The off limits areas are made inaccessible with safety gates, locks, door knob covers and key pad. When the applicant is cooking the kitchen will be made inaccessible to children with a safety gate. The entrance door to the garage is locked with a key and motion sensor activates when the door opens..
The applicant will utilize the fenced backyard for outdoor activities. The LPA informed the applicant to ensure children are supervised at all times during outdoor activities. The backyard has a dog run and it’s made inaccessible with toggle latch on both sides. The applicant stated there are no bodies of water, and LPA did not observe any bodies of water during the inspection.

The fire extinguisher is rated 2A10B: C and is located in the kitchen; smoke and carbon monoxide detectors meet requirements and are operational. Detergents, cleaning compounds, and medicines are inaccessible to children in care, and poisons are to be locked away. There is no fireplace on the premises. Children’s toys and play equipment are available. The applicant has a working cell phone and land line. The applicant stated there are no firearms, other weapons, or ammunition in the home.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Claudia Amador
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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, ERIKA FAMILY CHILD CARE
FACILITY NUMBER: 136610591
VISIT DATE: 08/04/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The applicant Erika Hernandez maintains documentation of proof of control of the property for review by the Department. Applicant’s Mandated Reporter AB1207 training expires on 9/13/2023. The applicant completed 8 hours of preventative health which included nutrition, on 3/23/2019 and completed Lead Training on 2/16/2022. Pediatric CPR and First Aid certifications expire on 6/2023. Immunization records per SB792 were reviewed and met regulations. Required documents are posted.

Applicant and adult residents in the home have criminal record clearances and/or exemptions on file.
The applicant was reminded that all adults 18 and over living in the house, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption or transfer their existing clearance or exemption, prior to the 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.

LPA advised the applicant Erika Hernandez that prior to making alterations or additions to the home or grounds, the applicant shall notify the Department of the proposed change. Applicant Erika Hernandez states they are financially secure to operate a family child care home for children and will comply with all regulations and laws governing family child care homes.
The applicant does not plan on providing Incidental Medical Services (IMS) to clients at this time. The 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. LPA discussed California Megan's Law and provided the licensee with the following website: www.meganslaw.ca.gov.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Claudia Amador
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HERNANDEZ, ERIKA FAMILY CHILD CARE
FACILITY NUMBER: 136610591
VISIT DATE: 08/04/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA discussed the maximum capacity for a small family child care home: four (4) infants only, or six (6) children, no more than three (3) infants, or eight (8) children, no more than two (2) infants, one (1) child enrolled in kindergarten and one (1) child at least six years of age. Provider’s children under ten (10) who live in the home are included in the childcare capacity. If the assistant is under eighteen (18), the assistant must not be left alone with children at any time.

A Resource Packet was reviewed with the applicant, including information on the following: PIN20-24-CCP Safe Sleep Regulations, lead exposure, SIDS, shaken baby, child abuse reporting, community resources, children’s records, facility records, required postings, immunizations, unusual incident report, facility roster, car seat law, visual for ratio/capacity, fire/disaster drill log. The applicant was also informed the following items are prohibited during daycare operating hours (walkers, exersaucers, jumpers, and bouncy seats). Corporal punishment and smoking are not allowed in the daycare. LPA discussed Guardian with
applicant: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

LPA discussed the safe sleep regulations with the applicant and 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. LPA also informed the 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 registering all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA reviewed with the applicant Erika Hernandez 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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Claudia Amador
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4
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, ERIKA FAMILY CHILD CARE
FACILITY NUMBER: 136610591
VISIT DATE: 08/04/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders through Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms.
To receive important licensed-related information about 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. San Diego Regional Office Duty Line was provided: (619) 767-2248.

Southern California Child Care Advocate information was provided, and the applicant was encouraged to subscribe through the CCLD website in order to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

A Small Family Child Care Home license may be issued upon final file review. LPA Claudia Amador explained the inspection report to the applicant Erika Hernandez; the applicant stated she understood. An exit interview was conducted, and the report was reviewed with the applicant, Erika Hernandez.

No corrections are needed, and a license for eight (8) children will be issued August 6,2022. The last day at the current address is August 5,2022.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Claudia Amador
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4