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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845415
Report Date: 07/02/2021
Date Signed: 07/12/2021 03:07:10 PM

Document Has Been Signed on 07/12/2021 03:07 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:SERNA FAMILY CHILD CAREFACILITY NUMBER:
334845415
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
07/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Licensee, Hercilia SernaTIME COMPLETED:
02:15 PM
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On 07/02/2021 at 11:15am, Licensing Program Analyst (LPA) Destinee Hogue arrived at the facility to conduct a required annual inspection. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed with Licensee, Hercilia Serna:

Normal days and hours of operation are: Monday - Friday from 6:00am to 6:00pm
OFF-LIMIT AREAS INCLUDE: Entire second floor, daughter's bedroom and bathroom on the first floor, garage, and partial backyard (fenced dirt area).

- No bodies of water present at the time of this inspection. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
- No guns or weapons present as stated by the Licensee. Licensee understands all guns, weapons and ammunition must be key-locked separately and made inaccessible per Title 22 regulations.
- Storage areas for poisons are observed to be inaccessible and stored behind in off limit garage.
- All hazardous items were not observed to be inaccessible, at the time of this tele-inspection. While touring the facility, LPA Hogue observed a green grill lighter being stored in a kitchen drawer and a bottle of Lysol disinfectant spray was stored under an unlatched kitchen cabinet. LPA Hogue issued an Advisory Note-Technical Violation notice during this tele-inspection.
- There is no fire place at the facility.
- Appropriate fire extinguisher, smoke detector and carbon monoxide detector is present and were tested by the applicant during this inspection.
- Home is clean and orderly, with heating and ventilation for safety and comfort
- Stairs are barricaded at this time
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: SERNA FAMILY CHILD CARE
FACILITY NUMBER: 334845415
VISIT DATE: 07/02/2021
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- Safe and appropriate toys and equipment are present for indoor activities. While inspecting the outdoor play area, LPA observed daycare bicycles without bike handles/bike coverings on handles. LPA issued an Advisory Note-Technical Violation during this inspection.
- A working telephone is present
- There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.
- All cribs or play yards shall meet the United States Consumer Product Safety Commission safety standards.
- Placement of cribs or play yards shall not hinder entrance or exit to and from the space where infants are sleeping.
- Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.
- Mattresses shall be made specifically for the size crib or play yard in which they are placed.
- Fitted sheets shall be replaced when wet or soiled.
- Each infant's bedding shall be used for him/her only. Bedding that touches the infant’s skin shall be cleaned at least weekly or before use by another infant.
- Soiled bedding shall be placed in a closed container and made inaccessible to infants until washed.
- Cribs or play yards shall be free from all loose articles and objects.
- Pacifiers shall be allowed in the crib or play yard if the following provisions are in place: There shall not be anything attached to the pacifier; The pacifier shall be specific to the infant it is being given to; Bumper pads shall not be used; There shall be no objects hanging above or attached to the side of the crib.
- The home shall be kept clean and orderly, with heating and ventilation for safety and
comfort.
- The home shall provide clean, safe and age appropriate toys, play equipment, and material. While inspecting the outdoor play area, LPA observed bird feces on top of a toy truck that is located in the outdoor play area.
- Licensee understands when temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children.
- Licensee understands she shall ensure that children in care are supervised at this time.
- Children shall not be left in parked vehicles.
- Outdoor play areas are fenced, and appropriate supervision was observed at the time of this inspection.
- The facility is operating within the licensed capacity and appropriate ratios were observed at the time of this inspection.
- An infant shall not be swaddled while in care.
- Car seats shall only be used for transportation purposes and shall not be used for sleeping.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: SERNA FAMILY CHILD CARE
FACILITY NUMBER: 334845415
VISIT DATE: 07/02/2021
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- The Licensee shall supervise infants while they are sleeping and adhere to the following requirements: The Licensee shall physically check on sleeping infants every 15 minutes; The Licensee shall document the following: Labored breathing; Signs of distress; skin color, increase in body temperature, and restlessness; Infants up to 12 months of age who are sleeping in a position other than on their back.
- Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Date; Infant’s name; Time of each 15-minute check.
- If the provider observes labored breathing or signs of distress…the provider shall do the following: Immediately notify the infant’s authorized representative; Obtain specific instruction from the infant’s authorized representative regarding action to be taken and make prompt arrangements to obtain medical treatment if necessary; There shall be no delay in obtaining emergency medical treatment for the infant if the infant’s condition requires immediate attention; The provider shall be near enough to the sleeping infant to be able to hear them wake up
- If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times; The provider shall be able to visually observe the infant without moving the door; the provider shall be on the same floor as the sleeping infant; A digital video and audio monitoring device may be used in the home but shall not be used in place of the requirements.
- The Licensee shall place infants up to 12 months of age on their backs for sleeping.
- Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the Licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
- When a child shows signs of illness he/she shall be separated from other children and the nature of the illness determined. If it is a communicable disease he/she shall be separated from other children until the infectious stage is over.
- Each child’s file contains a copy of the emergency information card with required information
- Pediatric CPR and First Aid Card expired on 10/2020. Licensee has not renewed her CPR/First Aid card
- AB 1207 Mandated Child Abuse Reporter Training expired on 12/19/2020. Licensee has not renewed her AB1207 Mandated Child Abuse Reporter Training. An Advisory Note-Technical Violation was issued during this inspection.
- Review of staff records contain proof staff are immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year or provide a statement denying the influenza vaccination.
- The Department shall notify a Licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons. The Licensee shall comply with the notice.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: SERNA FAMILY CHILD CARE
FACILITY NUMBER: 334845415
VISIT DATE: 07/02/2021
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- An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age and included in the infant's file at the facility. This plan shall be signed and dated by the infant’s authorized representative; The LIC9227 shall be maintained in the infant’s file and shall be available to the Department for review.
- Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed. All individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. This was verified on 07/02/2021.
- Any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice.

- The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

- The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

- The Duty Officer is available to answer questions Monday – Friday from 8:00am to 5:00pm at (951)782-4200

- AB2370 – Effective January 1, 2019 – Lead Poisoning – providers are required to provide a lead toxicity prevention handout to parents/guardians of newly enrolled and newly reenrolled children with information on risks and effects of lead poisoning; blood lead testing recommendations and requirements; and options for obtaining blood lead testing, including free and/or discounted testing. There will be a training component of this added to the Preventative Health Training beginning July 1, 2020.

- AB2231 (2016) – Increased Civil Penalties, effective July 1, 2017 – For failing to correct a violation the civil penalty is increased to $100 per day for EACH violation until corrected; For failing to correct a repeated violation the civil penalty is increased to $250 immediately assessed , and $100 per day afterwards for EACH repeated violation until corrected; For an Immediate Risk violation the civil penalty is increased to $500 immediately assess, and $100 per day for EACH violation after that until corrected; For any repeated Immediate Risk violations the civil penalty is increased to $1,000 immediately assess, and $100 per day afterwards for EACH repeated violation until corrected. NOTE: Repeat violations are defined as a violation of a previously cited statutory or regulatory Section and/or subsection within 12 months prior.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: SERNA FAMILY CHILD CARE
FACILITY NUMBER: 334845415
VISIT DATE: 07/02/2021
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- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov

During the exit interview, the Licensee, Hercilia "Mercedes" Serna confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279, LIC508 and TB Screen and have your child submit for LIVESCAN background clearance. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS. No deficiencies were cited during this inspection.

A copy of this report was provided to the licensee on this date and must be made available to the public upon request for the next three years.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021
LIC809 (FAS) - (06/04)
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