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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243910980
Report Date: 04/13/2021
Date Signed: 04/13/2021 03:35:22 PM

Document Has Been Signed on 04/13/2021 03:35 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:HERNANDEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
243910980
ADMINISTRATOR:HERNANDEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 588-0174
CITY:SANTA NELLASTATE: CAZIP CODE:
95322
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
04/13/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria HernandezTIME COMPLETED:
12:27 PM
NARRATIVE
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On 4/13/21, a case management inspection was conducted by Licensing Program Analysts (LPAs) Caroline Harris and Roman Iglesias. LPAs met with licensee Maria Hernandez and a was census is taken. LPAs toured the facility both inside and outside. The purpose of this report is to cite violations which were discovered during the visit.

"Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months." The licensee was provided a copy of the "Fact Sheet" for AB 633 (Parent Notification Requirements), along with a copy of the relevant documents this date. A completed signed copy of the LIC 9224 will be placed in each child's file.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, this deficiency is being cited on the attached LIC 809D.

An exit interview was conducted with the licensee, Maria Hernandez. A copy of this report and appeal rights were discussed and provided to licensee. A Notice of Site Visit Form was posted to the parent’s board and must be posted for 30 days.

SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2021
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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Document Has Been Signed on 04/13/2021 03:35 PM - It Cannot Be Edited


Created By: Caroline Harris On 04/13/2021 at 12:33 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: HERNANDEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 243910980

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/20/2021
Section Cited
CCR
102417(g)(4)

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Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children.

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A return visit will take place in order to clear this deficiency.
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This requirement was not met as evidenced by the LPA's observing sharp scissors, industrial glue, Tums and other medications, nail polish, and beer that were accessible to children. This is an immediate risk to the health, safety or personal rights of children 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:Alice Juarez
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/13/2021 03:35 PM - It Cannot Be Edited


Created By: Caroline Harris On 04/13/2021 at 12:42 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: HERNANDEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 243910980

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/20/2021
Section Cited
CCR
102416.2(b)

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Reporting Requirements. The licensee shall report to the Department any of the events as specified in Health and Safety Code Section 1597.467(b)(1)(A)
through (b)(1)(C) that occur during the operation of the family child care home.
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Licensee will review the training video on "Childcare Reporting Requirements" on the CCL website and write a statement that she understands the requirements and what the requirements are.
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This requirement was not met as evidenced by the licensee calling in an incident four days past the required 24 hours. This is a possible risk to the health, safety or personal rights of children in care.
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This statement will be available for review by the given due date of 4/20/21.

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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:Alice Juarez
LICENSING EVALUATOR NAME:Caroline Harris
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2021


LIC809 (FAS) - (06/04)
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