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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300848
Report Date: 07/21/2023
Date Signed: 07/21/2023 03:06:09 PM

Document Has Been Signed on 07/21/2023 03:06 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:HERNANDEZ-ROMERO FAMILY CHILD CAREFACILITY NUMBER:
336300848
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/21/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Antonia Perez Ledezma, Jose Fidel Hernandez RomeroTIME COMPLETED:
03:20 PM
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On date at 11:30AM, Licensing Program Analyst (LPA) Lorena Valenzuela arrived at the facility to conduct a pre-licensing inspection. Present during this inspection were: Antonia Perez Ledezma, Jose Fidel Hernandez-Romero, Ricardo Ledezma . The home has three bedrooms, one daycare room, three bathrooms, with attached garage. LPA toured the facility, inside and out with Antonia Perez Ledezma and Jose Fidel Hernandez Romero and the following was observed and/or discussed:

· Per updated Applicant Antonia Perez Ledezma, Off-limit areas include kitchen, parts of the backyard, all bedrooms, bathroom 2 by hallway, making them inaccessible to children.
· Normal hours of operation will be: Monday to Friday, 5:00am to 4:30pm
· Smoke detectors and Carbon Monoxide detectors were tested by the applicant during this inspection and were in working order.
· There is central heating and air conditioning.
· The fire extinguisher is fully charged and meets standards established by the State Fire Marshal.
· All hazardous items were observed to be inaccessible. Storage of poisons and toxins are inaccessible to children and locked in the laundry room. Sharp items including kitchen knives, are inaccessible and stored in a locked kitchen drawer. Medicines are locked and stored in master bedroom closet.
· First Aid Kit is located in hallwall closet, and contains all required items.
· No guns or weapons are stored in the facility as of this date. Applicant understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations.
· This is a one story home
· There is no fireplace
· Clean, safe and age-appropriate toys were observed.
· LPA observed a working telephone and is a mobile phone number.
· There were no toxic plants inside or outside the facility observed at this time
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: HERNANDEZ-ROMERO FAMILY CHILD CARE
FACILITY NUMBER: 336300848
VISIT DATE: 07/21/2023
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 The outside activity area consists of: turf grass, cement area and portable playground
· There are no bodies of water observed on this date. Applicant understands all bodies of water including ponds, above ground pools and spas, in-ground pools and 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 bodies of water described. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.
· Applicant will be transporting children. Applicant will be using van to pick-up and drop-off children. The vehicle is in safe operating condition.
· Verification of control of property is maintained by applicant
· Facility Sketch and Emergency Disaster Plan are not posted.
· Pediatric CPR and First Aid Card expires 04/2025
· Mandated Reporter certificate expires 07/26/2024
· Preventive Health and Safety training, including nutrition and lead components was completed on 06/14/2023 & 07/11/2023.

Applicant was reminded all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

The applicant provided proof of control of property. However because the applicant is not property owner, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC9149).

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) or (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
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: HERNANDEZ-ROMERO FAMILY CHILD CARE
FACILITY NUMBER: 336300848
VISIT DATE: 07/21/2023
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LPA reviewed with applicant, licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

On this date, The California Attorney General – Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California’s Megan’s Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: HERNANDEZ-ROMERO FAMILY CHILD CARE
FACILITY NUMBER: 336300848
VISIT DATE: 07/21/2023
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The following items were also reviewed with the applicant during inspection:
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months
- Responsibilities of being a mandated reporter and updating training every 2 years
- Personal rights of children in care, including no corporal punishment
- Responsibility to know the Title 22 Regulations for anyone providing care and supervision
- Capacity and Supervision requirements
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility phone numbers must always be on file with the licensing office
- Baby walkers, bouncy seats, exer-saucers, and other similar items are prohibited
- Car seat law
- Smoking is prohibited in the facility while providing child care or transporting children
- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of
30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also
be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
- Applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
-The Applicant can submit fingerprint transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov
- Access to forms & Title 22 Regulations for Family Child Care Homes online at www.ccld.ca.gov
- The Duty Officer is available to answer questions Monday – Friday 8:00am to 5:00pm at: 951-782-4200.
Before licensure, the following needs to be corrected/completed:
1. Parent board with all required postings
2. Tuberculosis test of clearance for adult living (A1) in the home
3. Orientation certificate for applicant Antonia Perez Ledezma
4. Applicant stated Background clearance was processed for Adult 1 , who lives in in the home. This will be verified by LPA Valenzuela. Applicant understands background clearance or exemption is needed prior to licensure.
5. LPA obtained documents from applicant that will be reviewed by LPA and supervisor for floor plan approval
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: HERNANDEZ-ROMERO FAMILY CHILD CARE
FACILITY NUMBER: 336300848
VISIT DATE: 07/21/2023
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Once all corrections have been verified, the application for a small Family Child Care Home will be submitted for approval with a maximum capacity of 6 or 8 with parent notification. Applicant advised that all corrections are due within 30 days, or the application may be withdrawn.

At time that application was submitted Jose Fidel Hernandez Romero was applicant on LIC279. At the time of the inspection it was decided by both parties, that Antonia Perez Ledezma would be applicant and an updated LIC 279 was provided to LPA Valenzuela.

Exit interview conducted and report was reviewed with the applicant Antonia Perez Ledezma.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
LIC809 (FAS) - (06/04)
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