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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017321
Report Date: 09/05/2024
Date Signed: 09/05/2024 12:13:45 PM

Document Has Been Signed on 09/05/2024 12:13 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
198017321
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, NARDALINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 583-5906
CITY:HUNTINGTON PARKSTATE: CAZIP CODE:
90255
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
09/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Licensee Nardalina HernandezTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Anthony Padilla conducted an unannounced annual required inspection at the above facility on 9/5/24 at 9:40AM. LPA met with Nardalina Hernandez, Licensee who guided analysts on a tour of the facility.

There was 1 infant and 7 daycare child for a total of 8 total children and two adults present when LPA arrived. All adults present in the home have obtained a criminal record clearance or exemption. Facility capacity is in compliance for a large Family Child Care Home. Hours of operation are Monday- Friday 6:30AM- 5:30PM.

This is a one story home which consists of three Bedrooms, two Bathroom, Kitchen, Living Room, Dining Room, Den, detached garage, covered patio, back yard (fenced), front yard (fenced). Main care is provide in the den, patio and back yard. Children have access to the living room, dining room, and one bedroom for napping infant. Off Limit Areas include: Two Bedrooms, one bathroom, kitchen & detached garage. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA reviewed required posted documentation located on a board in the covered patio and in the den, which included facility License, Publication (PUB) 394- Notification of Parent Rights, Licensing Form (LIC) 9148- Earthquake Preparedness form, and LIC 610- Facility Disaster Plan. All documents were observed.

Facility records were reviewed for LIC 9040- Facility Roster and Disaster drill log. Last drill conducted on 8/17/24. All documents were observed. Smoke and carbon monoxide detectors, located in the in the kitchen and den were tested and operable during inspection. Fire extinguisher indicated fully charged and was serviced, 8/7/24. The home maintains telephone service via operable cell phone. LPA confirmed telephone number with licensee

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Anthony Padilla
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198017321
VISIT DATE: 09/05/2024
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There are toys and other age appropriate material available for children in the den, covered patio and backyard. LPA observed a menu, activity plan and daily schedule in the den. The covered patio has tables and chairs where children were observed to be eating snack. Some cleaning supplies were observed to be stored in the kitchen under the sink with a child lock. During inspection LPA observed a bedroom with an open door adjacent to the living room with a play yard that can be viewed from the main care area and also in the room was a baby changing table. Per licensee the isolation area for sick children waiting to be picked up is on a adult size couch in the living room, away from the other children. Home has central air and heat. Food is provided by Licensee. Per Licensee, there are no firearms or weapons stored in the home LPA did not observe any fire arms or weapons during time of inspection. Children nap in the den, living room and a part of the dining room.
The bathroom that children use is located off the hallway between the living room and the den. Bathroom was observed to be clean. LPA observed cleaning compounds in the cabinet under bathroom sink with 2 child locks fully latched making cleaning compounds inaccessible to children in care.

Infant Care: Currently licensee cares for one infant. LPA observed three play yards, two visible in the dining room and one in the nap room. Napping equipment does not block entrances or exits. Play yards were observed to have standard flat matt with tightly fitted sheets. LPA did not observe loose object, bumpers, objects hanging, or objects attached to the play yard. Per licensee wet or soiled sheets are changed and washed weekly. LPA discussed Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months and 15-minute sleep check documentation for infants 0-24 months. Licensee states the following a sleep supervision plan for infants: Infant naps in the main care area where they can be supervised at all times.
Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be gated. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. Children to do not have access to the entrance of detached garage. There are no pools or spas, or other bodies of water.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). All documents were complete. PAGE 2
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Anthony Padilla
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198017321
VISIT DATE: 09/05/2024
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Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508- Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. At 11:00 AM LPA observed that Staff 2 (S2) has current Pediatric first aid and CPR and expires 5/15/25 but the CPR training received was not EMSA certified. LPA issued a Technical Violation (TV) to licensee for S2 not having proof of current EMSA approved Pediatric CPR and First aid.

During inspection children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

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 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.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Anthony Padilla
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198017321
VISIT DATE: 09/05/2024
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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/.

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

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

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

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

Exit interview conducted and report was reviewed with the licensee Nardalina Hernandez). PAGE 4

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Anthony Padilla
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4