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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622275
Report Date: 02/06/2025
Date Signed: 02/06/2025 10:10:38 AM

Document Has Been Signed on 02/06/2025 10:10 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GARCIA HERNANDEZ, GUADALUPEFACILITY NUMBER:
313622275
ADMINISTRATOR/
DIRECTOR:		GARCIA HERNANDEZ, GUADALUPFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 390-3107
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
02/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Guadalupe Garcia HernandezTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Jeremey McClain met with licensee Guadalupe Garcia Hernandez for an unannounced annual inspection.

LPA observed six children. Ages of children were verified during file review to ensure ratios were adhered to. Licensee stated there aren’t new residents in the home.

All individuals subject to criminal record review have obtained clearance. 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 toured areas of the home accessible to the children. The off-limit areas of the home were inaccessible. Equipment and furnishings in areas where children are active appeared to be safe and in working order. LPA did not observe any standing bodies of water during today’s inspection.

LPA observed current CPR/First Aid certificate which expires 1/2026. LPA observed the following posted: a license, a Parents' Rights Poster and an Emergency Disaster Plan. Licensee’s AB1207 Mandated Reporter training has expired. LPA provided Licensee with website: http://childcare.mandatedreporterca.com/ and reminded the licensee that the training must be completed once every two years. LPA reviewed children's records for completeness, as well as the client roster. LPA observed records of immunizations for MMR, Pertussis, and influenza. LPA observed fire drills documented on a calendar, indicating that the licensee is conducting disaster drills at least once every 6 months.

LPA observed that hazardous items: detergents, cleaning compounds, medication, sharp utensils, and other items that could pose a danger to children in care, are properly stored out of children's reach. Continued...
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GARCIA HERNANDEZ, GUADALUPE
FACILITY NUMBER: 313622275
VISIT DATE: 02/06/2025
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LPA observed a fireplace that was properly screened. Stairs were properly barricaded. LPA observed a working telephone in the home. Licensee stated that there are no weapons in the home. LPA observed a fire extinguisher which licensee stated was serviced or change within the past year. Carbon monoxide and smoke detectors were tested and observed to be functional.

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

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.

No deficiencies were observed during today’s inspection.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Guadalupe Garcia Hernandez.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
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