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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494722
Report Date: 12/16/2021
Date Signed: 12/16/2021 03:20:14 PM

Document Has Been Signed on 12/16/2021 03:20 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:HERNANDEZ DE ALVAREZ FAMILY CHILD CAREFACILITY NUMBER:
197494722
ADMINISTRATOR:HERNANDEZ DE ALVAREZ, MARTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 223-2165
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 10DATE:
12/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Lilliana Alvarez-Hernandez - Adult daughterTIME COMPLETED:
01:30 PM
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On 12/16/2021 Licensing Program Analyst (LPA), Jillinda Chandler conducted an unannounced Annual Random/ I year required visit for Alvarez Hernandez Family Child Care Home. Present in the home were licensee Marta Alvarez Hernandez, two assistants; Lilliana and Teresa Hernandez and 11 daycare children. The home is a single family, single story home. The home consists of a living-room, kitchen, 3 rooms and one bathroom, the room on the right of the hall was off limits to children in care and was observed to be locked, the room on the left was dedicated to infants in care.The restroom was inspected cabinets were locked and no toxins or detergents were observed. LPA observed the home to have a barricaded wall heater, LPA informed Lilliana that the gate needs to be secured to ensure inaccessibility to children in care. The home was inspected inside and out for Health and Safety compliance per Title 22 according to the facility sketch.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ DE ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197494722
VISIT DATE: 12/16/2021
NARRATIVE
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LPA observed the following:
Care and supervision were observed, LPA observed two toddlers being supervised by assistant Teresa in the infant room and 10 daycare children under the supervision of the licensee and her adult daughter Lilliana.
The homes capacity was within the scope of the license
Appropriate size fire extinguisher carbon and smoke detector present & operable.
Detergents, and knives were inaccessible, Toxins were locked and inaccessible.
The homes kitchen was inaccessible to children in care, with child proof gates at each entry.
No guns or weapons present as stated by the Licensee, no weapons observed by LPA. The home as a properly working telephone
LPA observed the homes parent notification board; the license, facility sketch, Emergency Disaster Plan, Notification of Parent’s Rights Poster, and California Safety Seat Law were posted. Safe Sleep and Lead Poison Awareness information was provided for posting
A first aid kit was observed containing the required supplies: scissors, tweezers, bandages, medical ointment and a thermometer. At least one person in the home was certified in Pediatric CPR and First Aid
No bodies of water were observed on the premises
Children records available and in good order.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021
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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ DE ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197494722
VISIT DATE: 12/16/2021
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 All adult’s present records were reviewed and were observed to be updated and current
Licensees Mandated Reporter certificate expires 11/1/2022
A roster was readily available for review and current.
Parents and authorized adults sign children in and out using an electronic devise, licensee was informed that the devise must be capable of printing a coping of signatures upon request from and authorized enforcement agency for a three-year period
Licensee does provide Incidental Medical Services (IMS).
All adults in the home have completed and cleared a Criminal Background Clearance.
Toys, equipment and materials available and in good order Children napped in cribs, and were found to be in good condition. Infant safe sleeping was discussed with licensee, play pens used for infant sleeping were observed with the appropriate mat and tight-fitting sheets, no toys or other items were observed inside of the play pens
LPA reminded licensee that children are only to use car seats during transportation, and appropriate children’s feeding chairs shall only be used during mealtime.
Outdoor activities were conducted in the backyard LPA did not observe any hazardous conditions in this area. The yard was fully enclosed with a 4 feet or higher gate, LPA observed toys and equipment in good repair.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021
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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ DE ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197494722
VISIT DATE: 12/16/2021
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Representative Lilliana Alvarez-Hernandez was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the representative Lilliana Alverez-Hernandez

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021
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Document Has Been Signed on 12/16/2021 03:20 PM - It Cannot Be Edited


Created By: Jillinda Chandler On 12/16/2021 at 11:53 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 DE ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197494722

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102423(a)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above Child (C1) requires an epi-pen LPA observed the child's prescription to be expired 9/2020 and child was present in the home during todays inspection and no medical prescription on file, which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/21/2021
Plan of Correction
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Licensee shall instruct the parent to provide a current prescription with a physician prescription by 12/21/2021. Licensee shall provide copies of the currents precribtion to the department no later thanthe due date of 12/21/2021
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Peter Flores
LICENSING EVALUATOR NAME:Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2021


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