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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300806
Report Date: 12/09/2024
Date Signed: 12/09/2024 09:56:20 AM

Document Has Been Signed on 12/09/2024 09:56 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
336300806
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ,SARAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 957-5714
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
12/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee, Sarah HernandezTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Child 1 (C1)- Santiago Porras, DOB: 12/4/2024
Licensee (L)- Sarah Hernandez
Staff 2 (S2)- Nicholas Hernandez

On December 09, 2024, at 9:00 AM, Licensing Program Analyst (LPA) Brian Morris arrived at the facility to conduct a Case management incident follow-up visit on an Unusual Incident Report (UIR) received by the Department on 10/22/2024. LPA met with Licensee Sarah Hernandez to discuss the incident. A tour of the facility was granted, and census was conducted.

It was reported to the department that on 10/17/24, C1 was playing soccer outside in the backyard area with other children. C1 attempted to kick a soccer with their left leg and missed the soccer ball and their momentum caused them to spin around and fall fracturing their right leg. Licensee reports that once C1 was injured, staff quickly sat C1 down to observe the area of concern. Staff began soothing and medical treatment (Ice Pack) administered by staff. C1 was emotional and crying, L went to pick up C1 and they could not put weight on their leg, and they were crying in pain. L sat with C1 and began to ask him questions, C1 was able to point to the affected area, their right leg. L called mom, C1s mother arrived quickly after being contacted by our facility to pick C1 up and take them for medical attention. Licensee reports, C1 returned to the facility with restrictions on 10/21/2024 (Monday). Licensee reported that the daycare was within ratio and staffing was appropriate on 10/17/2024. The Licensee stated that C1 did miss a day but only because the mother of C1 to keep the child at home and observer for a day prior to C1 returning to the facility. C1 returned to the facility with a stroller and a full leg cast and restrictions. Facility staff adjusted their program to meet the needs of C1 while they recover. Staff transported C1 while at the facility and pushed C1 in their stroller while inside and outside of the facility. C1 was able to sit and observe the outdoor time and play catch while seated in his stroller with staff at the facility.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Brian Morris
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 336300806
VISIT DATE: 12/09/2024
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LPA has determined that the facility has taken the necessary steps in ensuring that the personal rights of the children in care were not violated.

Based on the information gathered, there appears to be no violations of Title 22 Regulations found at this time, and therefore, there were no deficiencies cited during this visit.

An exit interview was conducted, and a copy of this report was provided to Licensee Sarah Hernandez. A Notice of Site Visit was issued, and the director understands that it must remain posted for 30 days.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Brian Morris
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC809 (FAS) - (06/04)
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