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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192009032
Report Date: 07/01/2024
Date Signed: 07/03/2024 01:58:51 PM

Document Has Been Signed on 07/03/2024 01:58 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
192009032
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, YRAYDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 344-7214
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 21DATE:
07/01/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Maria Blas Navarro-AssistantTIME VISIT/
INSPECTION COMPLETED:
07:17 PM
NARRATIVE
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This is an amendment of an original report created on 07/01/24.

On 7/1/24 at 12:15 pm Licensing Program Analysts (LPA), Jeanine Lipsey conducted an unannounced Required Annual Inspection and was met by Maria Blas Navarro-Assistant. Licensee was out of the country in Spain for an emergency. Licensee disclosed via phone, parents were verbally informed of her absence. Entrance check list was provided to the assistant. LPA observed twenty one children in care today. Capacity as specified on the license was not being maintained. Days and hours of operation are Monday through Friday 7am to 6pm. Licensee does not have liability insurance, LIC 282 were observed in files.

LPA Lipsey observed the following required postings: License, LIC610A Emergency Disaster Plan, PUB 394 Notification of Parents’ Rights Poster, and LIC 9148 Earthquake Preparedness Checklist. LPA advised all LIC9213 Notice of Site Visits shall be posted for 30 days after each site visit. LPA advised, any licensing report documenting a Type A citation must be posted for 30 days. LPA advised a disaster drill log shall be available with disaster drills completed at lease every six months.

LPA toured the living room and the outside area. This is a 1 story, 4-bedroom, 2.5 bathroom home with living room, kitchen, and attached garage. The areas that are accessible to children: are the play room, bathroom, and the backyard for outdoor activities. LPA observed 2 small dogs behind the house behind a mesh fence, and 2 sheds, on with a baby walker. Licensee disclosed via phone, one was for storage and the other for the older kids to watch TV and stay out of the sun. LPA observed 1 adult female and 8 children hiding in the shed.

LPA did not observe any poisons present during the inspection. Per Licensee via phone, the detergents, cleaning compounds, medication and other hazardous item will be made inaccessible to children.

page 1 of 4

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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 22
Document is an Amendment of Original Document on 07/02/2024 09:54 AM


Created By: Jeanine Lipsey On 07/01/2024 at 04:05 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation, interview , & record review, the licensee did not comply with the section cited above in that licensee's aunt Maria Debera, date of arrival 6/30/24, who was hiding in the shed, does not have finger print clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2024
Plan of Correction
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2
3
4
Licensee will have Maria Debera, who is house sitting, to not be around the children and stay in her room until licensee returns on 7/5/24.
Type A
Section Cited
CCR
102391(b)
Inspection Authority of the Department
(b) The licensee shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations. The Department shall exercise this authority as specified in Health and Safety Code Section 1596.8535(a).

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
n/a
POC Due Date: 07/01/2024
Plan of Correction
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2
3
4
 N/a
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:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024


LIC809 (FAS) - (06/04)
Page: 2 of 22
Document Has Been Signed on 07/01/2024 08:30 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 07/01/2024 at 04:05 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(a)
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 is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation, the licensee did not comply with the section cited above in that licensee had 21 children which exceded the capacity of 14 children at one time which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2024
Plan of Correction
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Parents picked children and brought the ratio down to 12 children an 1 infant.
Type A
Section Cited
CCR
102391(a)
Inspection Authority
The licensee shall permit the Department to inspect any part of the family child care home in which family child care services are provided or to which children have access.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in the assistant did not unlock shed in the backyard after LPA heard a baby crying which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2024
Plan of Correction
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Licensee will open what ever is needed going forward
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:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2024


LIC809 (FAS) - (06/04)
Page: 4 of 22
Document Has Been Signed on 07/01/2024 08:30 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 07/01/2024 at 04:05 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that the fire extinguisher was last serviced June 2017, which should be serviced yealry, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2024
Plan of Correction
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Licensee will purchase or get serviced by due date and send proof via email.
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in that there is no record of fire drill conducted which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2024
Plan of Correction
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Licensee will conduct fire drills and send proof via email.
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:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2024


LIC809 (FAS) - (06/04)
Page: 5 of 22
Document Has Been Signed on 07/01/2024 08:30 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 07/01/2024 at 04:05 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(10)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above in that a Baby walker was in backyard shed where children play which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2024
Plan of Correction
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Licensee will send home with parent at pick up today.
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in the licensee does not record of infant 15 min checks which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2024
Plan of Correction
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Licensee will send proof of documentation of 15 min checks via email by POC date.
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:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2024


LIC809 (FAS) - (06/04)
Page: 6 of 22
Document Has Been Signed on 07/01/2024 08:30 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 07/01/2024 at 04:05 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in that 3 out of 3 staff do not have proof of Mandated reporter training, which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2024
Plan of Correction
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2
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Licensee will send proof of training via email by POC date.
Type B
Section Cited
CCR
102416.3(a)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation interview, the licensee did not comply with the section cited above in that licensee constructed a play room in a shed in the backyard for the older children to watch TV and did not report to the department which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2024
Plan of Correction
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2
3
4
Licensee will send a letter to the department about the shed in the back yard explaining its purpose and how it will be used via email by the POC date.
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:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2024


LIC809 (FAS) - (06/04)
Page: 7 of 22
Document Has Been Signed on 07/03/2024 02:04 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 07/03/2024 08:29 AM


Created By: Jeanine Lipsey On 07/01/2024 at 04:05 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 3 out of 3 staff do not have proof of Immunization's and flu vaccination/declination which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2024
Plan of Correction
1
2
3
4
Licensee will send proof of TB and flu vaccination/declination via email by POC date.
Type B
Section Cited
CCR
102368(a)
License
(a) The license shall be available in the facility upon request.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
na
POC Due Date: 07/05/2024
Plan of Correction
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2
3
4
na
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:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2024


LIC809 (FAS) - (06/04)
Page: 8 of 22
Document Has Been Signed on 07/01/2024 08:30 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 07/01/2024 at 04:05 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 3 out of 7 records reviewd did not poses proof of immunizations records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2024
Plan of Correction
1
2
3
4
Licensee will provide proof of records via email by POC date.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(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 is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that the licensee does not have a currebt roster which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2024
Plan of Correction
1
2
3
4
Licensee send copy of roster via email by POC date.
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:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2024


LIC809 (FAS) - (06/04)
Page: 10 of 22
Document Has Been Signed on 07/03/2024 02:05 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 07/02/2024 10:03 AM


Created By: Jeanine Lipsey On 07/01/2024 at 05:52 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102402(a)(3)

conduct in the operatiojn or maintence of a family day care home which is inimical to the health, morals welfare,or safety of ither and indeicdual in or receiving services from the facility or the people of the State of California.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview the licensee did not comply with the section cited above in that the Licensee lied about having children hiding the shed which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2024
Plan of Correction
1
2
3
4
Licensee going forward will disclose all children present and not hide them.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2024


LIC809 (FAS) - (06/04)
Page: 13 of 22
Document Has Been Signed on 07/01/2024 08:30 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 07/01/2024 at 06:13 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102371
Fire Safety Clearance
(a) A fire safety clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal shall be required for a large family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation the licensee did not comply with the section cited above in twenty one children were present and fire clearance is only for fourteen children which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2024
Plan of Correction
1
2
3
4
Licensee will only serve the capcity of 14 children
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Betty Bell
LICENSING EVALUATOR NAME:Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2024


LIC809 (FAS) - (06/04)
Page: 15 of 22
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009032
VISIT DATE: 07/01/2024
NARRATIVE
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4
5
6
7
8
9
10
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13
14
15
16
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19
20
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23
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25
26
27
28
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Per licensee via phone, there are no firearms, or weapons on the premises. LPA did not observe any bodies of water on the premises. LPA observed the home to be free from defects or conditions which may endanger the children. The kitchen was made inaccessible to children in care with a safety gate.

LPA observed fully stocked first aid kit. LPA Lipsey observed a working carbon monoxide/ smoke detector in the playroom. LPA was able to hear a successful test. Fire extinguisher 2A10BC was observed, located on the wall of the playroom, and was last purchased on 6/17/17. Electrical outlets were observed to be inaccessible to children in care with the use of plug covers. The home was observed to be clean and orderly with heating and ventilation. LPA observed safe toys, play equipment, and materials. LPA verified the home has a working telephone service. There are no stairs in the home.

LPA observed the outdoor area to be fenced and free from hazards. Licensee ensures that children in care are always supervised.

Licensee’s pediatric CPR/First Aid was completed Oct.1, 2023, Licensee and staff will take Mandated Reporter Training.

This home does not provide Incidental Medical Services – IMS. When a child is ill, they will be separated from the other children. Isolation area will be in the living room.

For IMS information see PIN 22-02-CCP. 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 Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

On this date, 7/01/24 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.

Page 2 of 4

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
LIC809 (FAS) - (06/04)
Page: 16 of 22
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009032
VISIT DATE: 07/01/2024
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at: www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded via the phone, that all adults 18 and over living or working in the home, 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. Upon review of the of the Guardian associations, LPA noted that Aunt Maria Debera was not finger printed and arrived on 6/30/24 to house sit for licensee until she returns.

LPA discussed the safe sleep regulations with licensee 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 licensee [or facility representative] 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.

page 3 of 4

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
LIC809 (FAS) - (06/04)
Page: 20 of 22
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009032
VISIT DATE: 07/01/2024
NARRATIVE
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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)/ (800) 514-0383

(TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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

During the exit interview, the Licensee via phone, confirmed that there are no Registered Sex Offenders living in the facility and support staff completed the RSO profile in FAS.

Based on LPA's observations, the following deficiencies listed on the attached LIC809D (deficiency page) are being cited in accordance with Title 22, Division 12, Chapter 3, of the California Code of Regulations. Deficiencies that are being cited need to be cleared to protect the children's health & safety.

Exit interview conducted and report was reviewed with the Assistant Maria Blas Navarro.

A notice of site visit was given and advised Assistant that it must remain posted for 30 days.

Page 4 of 4

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
LIC809 (FAS) - (06/04)
Page: 18 of 22