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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629976
Report Date: 06/10/2024
Date Signed: 06/10/2024 12:39:55 PM

Document Has Been Signed on 06/10/2024 12:39 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HERNANDEZ, ROSA FAMILY CHILD CAREFACILITY NUMBER:
376629976
ADMINISTRATOR/
DIRECTOR:		ROSA HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 640-0345
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
06/10/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Rosa Hernandez and Maritza HernandezTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 6/10/2024 at 9:45am, Licensing Program Analyst (LPA) Vicky Williamson conducted an announced pre-licensing inspection for the purpose of a change of location with applicant, Rosa Hernandez. The purpose of the inspection is to ensure the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Also present was licensees' daughters Martiza Hernandez and Maria Nevarez who aided as translators due to applicant's primary language is Spanish. Days and hours of operation are Monday through Friday, 5:00am - 6:30pm.

The applicant provided proof of control of property. This second level 4 bedrooms, 2 bathrooms home was toured and inspected. Applicant will utilize the following areas for childcare: living room, kitchen, dining room bedroom #1 (playroom), bathroom #1 (hallway, backyard and front yard. Off limit areas include bedroom #2, bedroom #3, bedroom #4 (master), bathroom #2 (inside of master bedroom), garage and fenced area behind and on the side of garage. Off limit areas are inaccessible to children by use of door knob covers, fencing and safety latches. LPA reminded applicant to ensure children are supervised at all times during outdoor activities.

The fire extinguisher is rated 2-A:10-B:C and is located in the kitchen, smoke and carbon monoxide detectors meet requirements and are operational. Poisons, detergents, cleaning compounds, medications and other hazardous items were made inaccessible. There is a entertainment center in the living room that has an electric fireplace insert. Applicant stated the fireplace is currently not in use and used for decorative purposes only. Applicant has children's toys, play equipment and books available. The applicant has a working home and cell phone. Applicant stated there are no bodies of water on the premises. Applicant stated there are no firearms, other weapons or ammunition in the home.

See LIC 809C Continuation...

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HERNANDEZ, ROSA FAMILY CHILD CARE
FACILITY NUMBER: 376629976
VISIT DATE: 06/10/2024
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LPA advised applicant that prior to making alterations or additions to the home or grounds, the applicant shall notify the Department of the proposed change. Applicant states that he is financially secure to operate a family childcare home for children and will comply with all regulations and laws governing family childcare homes.

Applicant was reminded that 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.


Applicant completed Mandated Reporter AB1207 training on 4/20/2024 and assistant Maritza Hernandez on 5/20/2024. Applicant completed 8 hours of preventative health which included nutrition and lead training on 6/2/2024. Pediatric CPR and First Aid certification expires on 4/2026 for applicant and assistant Maritza Hernandez on 5/2026. Immunization records per SB792 were reviewed and are complete for applicant and assistant. Required documents were posted during the time of inspection.

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.

LPA reviewed with applicant 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. Applicant was also informed the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care.

See LIC 809C Continuation...

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HERNANDEZ, ROSA FAMILY CHILD CARE
FACILITY NUMBER: 376629976
VISIT DATE: 06/10/2024
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On this date, 6/10/2024, the California Attorney General - Megan’s Law website (meganslaw.ca.gov) 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 addresses. 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.


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.

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.

Please visit the Guardian web page and set-up your Guardian account. https://cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian. If you have any questions regarding Guardian, please contact CDSS at email: guardian@dss.ca.gov.

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 platforms.

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. See LIC 809C Continuation...
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HERNANDEZ, ROSA FAMILY CHILD CARE
FACILITY NUMBER: 376629976
VISIT DATE: 06/10/2024
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Southern California Child Care Advocate information was provided, and applicant was encouraged to subscribe through the CCLD website to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

The agency received a granted fire clearance approval dated 6/5/2024.

LPA and applicant discussed the maximum number of children for whom care shall be provided when there is an assistant in the home, including children under age 10 who live in the licensee's home shall be either: Twelve (12) children with no more than four of whom may be infants and 8 older children over the age of 2 years or Fourteen (14) children, with no more than three infants (birth to 24 months) and at least two of the children with 1 child enrolled in kindergarten and 1 child at least six years of age with landlord consent (LIC 9149).



A Large Family Child Care Home license will be issued effective 6/10/2024.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

Exit interview conducted and report was reviewed with the Applicant, Rosa Hernandez and applicant's daughter/assistant Maritza Hernandez translated this report in Spanish.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC809 (FAS) - (06/04)
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