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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019586
Report Date: 10/17/2022
Date Signed: 10/17/2022 10:24:38 AM

Document Has Been Signed on 10/17/2022 10:24 AM - 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
198019586
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
10/17/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Sandra Hernandez, LicenseeTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Mireya Garcia conducted an announced licensee-initiated case management inspection. A risk assessment was conducted prior to entering the facility. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with licensee, Sandra Hernandez who guided analyst on a tour of the facility. The licensee's adult daughter was also present. There were 5 children present, 2 being infants. Licensee states that there are currently 8 children enrolled. The purpose for this inspection was due to the licensee's request to increase to a Large Family Child Care Home.

Family members residing in the home are 5 adults (criminal record clearances on file) and 1 minor child. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, living room/dining room, den, family room (main day care room), front yard (unfenced) and backyard (fenced). There is a pool in the premises that is located in a separate gated area section of the back yard. The children will have access to use both bathrooms, bedroom #1, living room/dining room, den, kitchen, family room (main day room), front yard (unfenced) and back yard (fenced). Applicant had latches on cabinets with any potentially hazardous material. Per licensee, areas off limits to children and parents include: Two bedrooms and the section back yard gated area where the pool is located. The LPA toured all areas used by children during this visit.
REPORT CONTINUES ON NEXT PAGE 1 OF 5.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2022
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019586
VISIT DATE: 10/17/2022
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Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. There were safe toys, play equipment and materials observed for children. LPA observed fireplace in the den room area that has been gated to be made inaccessible to the children in care. There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible in some areas of the home. Licensee states that there are no poisons in the home. The licensee does understand that poison must be locked with a key or combination lock.

LPA observed and inspected sleeping equipment for infants. LPA observed two play yards available in the family room (main day care room) that are used for napping. All equipment meets the US Consumer Product Safety Commission safety standards. LPA observed that play yards are free from loose articles and objects. There are no objects hanging above or attached to the side of the play yards. LPA observed that play yards do not hinder the entrance or exit to and from the space they are sleeping in. Mattresses were observed to be firm and covered with a fitted sheet that is appropriate to the mattress size. Each infant has their individual bedding and is washed weekly as required. Soiled bedding is replaced when wet or soiled and is placed in an area inaccessible to infants. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping.

LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was explained and issued to the Licensee. PIN 20-24-CCP Recently Approved Safe Sleep Regulations in Effect and Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed and a issued to the Licensee, including but not limited to documentation that shall be maintained.
*REPORT CONTINUES ON THE NEXT PAGE 2 OF 5.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019586
VISIT DATE: 10/17/2022
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Per licensee, there are two dogs (kept in the back yard gated section by the pool), no weapons or firearms on the premises. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was last serviced on 08/8/2022. Smoke detector and carbon monoxide detector in the den were tested at 9:54 am and are in operable condition. The licensee has current Pediatric First Aid and CPR, which will expire 06/2023.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee. The Licensee does have immunization documentation on file.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers
Licensee completed training on 03/15/2021.

*REPORT CONTINUES ON THE NEXT PAGE 3 OF 5.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019586
VISIT DATE: 10/17/2022
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The following was discussed:
· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearance prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
· The Licensee shall be present in the home and shall ensure that children are supervised at all times.
· Children shall not be left in park vehicles.
· The capacity specified on the license shall be the maximum number of children for whom care can be provided.
· Car seats shall only be used for transportation purposes and shall not be used for sleeping.
· All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
· When a child shows signs off illness, they will be separated from other children until the nature if the illness is determined.

LPA reviewed Forms/Records to Keep in Your Family Child Care Home.
CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting, and criminal record transfer requirements were discussed.

*REPORT CONTINUES ON THE NEXT PAGE 4 OF 5.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019586
VISIT DATE: 10/17/2022
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LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

At this time, the licensee is in compliance with California Code of Regulations Title 22. There is an approved fire clearance on file that was granted on 09/19/22. LPA reviewed COVID-19 precautionary measures during this inspection. At this time, the licensee home meets the description of a safe and healthy environment for children as described in Chapter 1, Division 12, Title 22 of the California Code of Regulations, and will be submitted for approval to be licensed as a Large Family Child Care Home.

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

Exit interview conducted and report was reviewed with facility representative, Sandra Hernandez.

REPORT ENDS HERE PAGE 5 OF 5 *
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5