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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216379
Report Date: 12/04/2024
Date Signed: 12/04/2024 11:32:51 AM

Document Has Been Signed on 12/04/2024 11:32 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
426216379
ADMINISTRATOR/
DIRECTOR:		JASMINE HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 354-3609
CITY:GUADALUPESTATE: CAZIP CODE:
93434
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
12/04/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Jasmine Alvarez-HernandezTIME VISIT/
INSPECTION COMPLETED:
11:45 PM
NARRATIVE
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On 12/4/24, at 9:35 AM, Licensing Program Analyst (LPA) Matthew Sapien conducted an unannounced Annual Random inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Jasmine Alvarez-Hernandez, Licensee of the FCCH, and explained the nature and purpose of the inspection. The LPA, in the company of Licensee, toured the interior and exterior of the FCCH. The FCCH is a 3-bedroom and 2-bathroom single-story house. The FCCH only utilizes the living room, guest bathroom, guest bedroom (converted playroom), and backyard area. The remainder of the home is excluded: 2 additional bedrooms, 1 additional bathroom, front yard, and garage. At the time of the inspection, there were 6 kids present, along with one additional staff member, and the Licensee's Husband (all cleared and associated).

LPA observed the FCCH to be orderly and clean. The bathroom, utilized for childcare services, is clean and free of toxins. Each bathroom cabinet contains items that aren't a danger to children in care. Cleaning compounds along with sharps were observed in the kitchen area in inaccessible locations. Cleaning compounds were stored in a secure cabinet beneath the sink. Sharps were stored in an elevated cabinet. Additional kitchen cabinets were observed to be inaccessible due to child safety latches. Personal medication is stored in an elevated cabinet in the hallway area. The Licensee informed the LPA that the FCCH possesses a First Aid Kit.

LPA observed age-appropriate books, toys, and other furnishings throughout the interior of the FCCH.

LPA observed appropriate licensing forms and documents posted prominently to a wall in the entry area of the FCCH. LPA observed an electric fireplace in the living room of the FCCH that is not used during day care hours. LPA also observed a combination smoke and carbon monoxide detector within the FCCH. At 9:59 AM, the combination carbon monoxide and smoke detector was tested. The detector was found to be operational.

LPA also observed a regulation fire extinguisher in the FCCH, which was last purchased on 12/4/24. LPA (CONT. 809-C, Page 2)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Matthew Sapien
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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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Document Has Been Signed on 12/04/2024 11:32 AM - It Cannot Be Edited


Created By: Matthew Sapien On 12/04/2024 at 10:35 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216379

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/18/2024
Plan of Correction
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Licensee will submit a current Mandated Reporter Training certificate to CCLD via email (matthew.sapien@dss.ca.gov) or text message (805-635-4725) to Matthew Sapien by the close of business day (5:00 PM) on 12/18/24.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Matthew Sapien
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2024


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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216379
VISIT DATE: 12/04/2024
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reminded the Licensee to service or purchase a regulation fire extinguisher annually. LPA reviewed the FCCH's fire/disaster drill log. The most recent fire drill occurred on 9/11/24.

As noted at the beginning of the report, the backyard is accessible to children in care. The FCCH's backyard is enclosed by secure wooden fencing throughout. The fence’s entry/exit points are secure. As is the case with the interior of the FCCH, the outdoor area has age-appropriate toys, play structures, and other equipment throughout the area that can afford for robust childcare services. Licensee was reminded to replace toys and play equipment which start to degrade or are not in good repair. The footing of the exterior is made up of varying surfaces (artificial turf and concrete pavement). Prior to permitting children to play outside, the Licensee attested that they make sure the area is safe and rid of any hazardous items for children in care. The Licensee also attested to LPA that children are always supervised when engaged in outside activity. LPA confirmed that the Licensee does not have any bodies of water on site. LPA observed 2 larger dogs at the FCCH within the garage. The Licensee informed the LPA that the dogs do not have interactions with children in care, however, they are up to date on their vaccinations.



LPA reviewed children's records. The records are current, complete, and possessed emergency contact information and immunization records, among other relevant licensing documents. The Licensee's records were also reviewed. The Licensee’s CPR/First Aid Training (EMSA approved), expiring on 9/25/26, is current and complete as are other relevant licensing documents and forms. Licensee was reminded to renew certifications and training prior to expirations. The Licensee informed LPA that there are no firearms or ammunition present within the FCCH.

The Licensee does currently provide Incidental Medical Services (IMS) and administers medication to children in care. IMS policy was discussed. For IMS information see PIN 22-02CCP. 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 discussed the safe sleep regulations with Licensee 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. (CONT. 809-C, Page 3)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Matthew Sapien
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216379
VISIT DATE: 12/04/2024
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LPA also informed Licensee 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.

Licensee 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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility when the LPA completed a RSO profile in FAS on 12/4/24.

During today's visit, 1 Type B Deficiency was cited based on LPA interview and record review pursuant to Title 22 of the CA Code of Regulations and Health and Safety Codes (see LIC809 D). Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the Licensee, Jasmine Alvarez-Hernandez.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Matthew Sapien
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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