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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192009032
Report Date: 07/03/2024
Date Signed: 07/03/2024 02:00:07 PM

Document Has Been Signed on 07/03/2024 02:00 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: 13DATE:
07/03/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:33 AM
MET WITH:Maria Blas Navarro-AssistantTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On 7/3/24, at 10:15am, Licensing Program Analyst (LPA's) Jeanine Lipsey & Suzette Ornelas conducted an unannounced Plan of Correction (POC) Visit. LPA's knock at the door and was not able to enter the facility until 11am and after parents were called. The assistant stated they were in the backyard and did not hear the door. After entering, LPA's disclosed the purpose of the inspection and met with the assistant Maria Blas Navarro, who guided the LPA's on a tour of the facility. The licensee was not present, out of the country in Spain, due to return 7/5/24. There were 13 children present during today’s inspection, of which 3 are infants. The facility was out of ratio. Two children were picked up by the parent which brought the facility into compliance. LPA also observed 2 Staff present plus Maria Debera who does not have fingerprint clearance at the time of this inspection.

During the Required - 3 Year inspection conducted on 7/1/24, the following deficiencies were issued.

· Type A - Type A: 102391(b) - Licensee refused to unlock storage shed in the back yard after LPA heard baby crying. POC: Clear LPA was able to inspect the entire facility including the backyard and the sheds.
· Technical Violation: 102417(d)(1) - Baby walker was observed in the shed where the children watch TV. POC: Not clear baby walker still present on the facility.
· Type A - 102416.5(a) - Licensee had total of 21 children and 3 of them were infants. POC: Clear Facility had thirteen children present which does not exceed the capacity.
· Type A 1596.871(c)(1)(A) - Maria Debera does not have fingerprint clearance. POC: Not Clear Maria Debera has not been fingerprinted and does not have any documentation.
· Type A – 102371- twenty-one children were present and fire clearance is only for fourteen. POC: Clear facility was at capacity with 13 children present.

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 4
Document Has Been Signed on 07/03/2024 02:00 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 07/03/2024 at 08:35 AM
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: 07/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/03/2024
Section Cited
CCR
102417(a)

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Operation of a Family Child Care Home” The licensee shall be present in the home and shall ensure that children in care are supervised at all times…Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement is not met as evidenced by:
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Licensee is due to return home by 7/5/24. Licensee will call the department going forward if they are going to be absent.
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Based on observation, the licensee did not comply with the section cited above in that Licensee is out of the country in Spain for emergency which poses a potential health, safety or personal rights risk to persons in care.
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Type A
07/03/2024
Section Cited
CCR102416.5(d)(2)(a)

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Staffing Ratio and Capacity
for a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home...No more than three infants are cared for during any time when more than 12 children are being cared for. This requirement is not met as evidenced by:
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Parents were called and 2 children were picked up which put the facility into compliance.
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Based on observation, the licensee did not comply with the section cited above in that the facility had 13 children, 3 them were infants.
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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: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: 2 of 4
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: 07/03/2024
NARRATIVE
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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.



The Notice of Site Visit was provided and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
Exit interview was conducted with the assistant Maria Blas Navarro and Appeals Rights provided.
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: 4 of 4
Document Has Been Signed on 07/03/2024 02:00 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 07/03/2024 at 12:01 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: 07/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/03/2024
Section Cited
CCR
102370(d)(1)

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Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:(1)Obtain a California clearance... This requirement is not met as evidenced by
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Licensee will have Maria Debera stay in the bedroom and not be around children. Licensee stated via phone, they will close after today and will reopen the facility on Monday so Maria Debera will not be around the children.
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Based on observation, interview & record review, the licensee did not comply with the section cited above in that Maria Debera, date of arrival 6/30/24, does not have finger print clearance which poses an immediate health, safety or personal rights risk to persons 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: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)
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