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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495062
Report Date: 09/07/2023
Date Signed: 09/07/2023 05:01:22 PM

Document Has Been Signed on 09/07/2023 05:01 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 FAMILY CHILD CAREFACILITY NUMBER:
197495062
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
09/07/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lesly HernandezTIME COMPLETED:
03:30 PM
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On 09/7/2023, Licensing Program Analyst (LPA) Veronica Wheatley conducted an announced Case Management inspection for the purpose of an increase in capacity. LPA met with Licensee Lesly Hernandez and toured the facility inside and out. The licensee is applying for a capacity increase from 8 to 14. Upon arrival, there are 1 child in care. Hours of operation Monday - Friday 7:30am to 5:30pm. A clearance was granted on August 22, 2023 by inspector Tim Tritenbach.

The single family home has 3 bedrooms and 2 bathrooms. The child care will be provided in the living room, and all bedrooms for napping. These areas were inspected by LPA and are safe to use for children. Applicant rents the home and provided control of property documentation.

The kitchen is off-limits. LPA observed child proof gates at the entrance of the kitchen and hallway.

LPA inspected the bathroom and did not observe any medications or poisons that could pose a potential risk to children in care. The kitchen was inspected. LPA did not observe any knives or sharp objects, detergents or cleaning supplies that would pose a potential risk to children in care. These items were made inaccessible to the children. The cleaning supplies are stored in the laundry room.

LPA inspected an enclosed backyard. LPA observed several age appropriate toys and equipment in the outside play area. LPA did not observe any bodies of water or pets. Licensee states no firearms on the premises.

LPA observed a charged fire extinguisher. The smoke detector and carbon monoxide detector are operable. Licensee has a first aid kit which includes band aids and a thermometer. The home has central air and heat.

Licensee has current CPR, first aid, health and safety which expires 7/2025. Licensee and assistants have mandated reporter training and immunizations on file.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197495062
VISIT DATE: 09/07/2023
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The parent board is posted for parents to view required information such as the license, parent's rights poster, personal rights, and emergency disaster plan. A copy of the children's roster will be kept accessible

Licensee was reminded 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.

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-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

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/.

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

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

A license to operate a Large Family child care home will be reviewed following final administrative review. Once approved a license will be granted for 14 capacity.

Exit interview conducted and report was reviewed with the licensee.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC809 (FAS) - (06/04)
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