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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153803286
Report Date: 09/10/2021
Date Signed: 09/10/2021 11:26:17 AM

Document Has Been Signed on 09/10/2021 11:26 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
153803286
ADMINISTRATOR:HERNANDEZ, SOLEDADFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 454-6120
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
09/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Soledad HernandezTIME COMPLETED:
11:40 AM
NARRATIVE
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On 09/10/2021, Licensing Program Analyst (LPA), Ruby Ocegueda conducted an unannounced Annual Required Inspection and was met by Licensee, Soledad Hernandez. LPA conducted a Covid-19 safety screening before entering the home. Licensee is Spanish Speaking. Days and hours of operation are Monday-Saturday 5:00 AM – 6:30 AM or others hours as arranged.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that the living room, dining area, converted garage and one hall bathroom is used for care. All other rooms are off-limits and made inaccessible by use of door knob safety covers. Licensee asked if her grandchildren who were present today could enter her inaccessible bedroom. LPA explained that if it was not previously approved, they could not enter during day care hours. Licensee did not want to make any other area inside the home accessible today. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Upon observation of the accessible bathroom, LPA observed three containers of disinfectant wipes and approximately 10 bottles of hand disinfectant gel. The items were both visible and accessible. Licensee confirmed this observation and stated she would move them.

There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (661) 454-6120. Report continued on 809-C.

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2021
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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Document Has Been Signed on 09/10/2021 11:26 AM - It Cannot Be Edited


Created By: Ruby Ocegueda On 09/10/2021 at 10:32 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 153803286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/24/2021
Section Cited
CCR
102417(g)(4)

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Operation of a Family Child Care Home. (g)The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger
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Licensee removed the disinfectant gel today. Licensee agreed not to have these items accessible in the future. Deficiency cleared today: 9/10/2021.
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if readily available to children shall be stored where they are inaccessible to children.This requirement was not met as evidenced by: observation. Multiple bottles of hand disinfenctant and wipes were accessible in the restroom. This poses a potential risk to the health, safety and or personal rights of children in care.
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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:Michael Duarte
LICENSING EVALUATOR NAME:Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2021


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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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 153803286
VISIT DATE: 09/10/2021
NARRATIVE
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There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. LPA reviewed the requirement for infants to be physically checked every 15 minutes and understands she should document any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infant sleeps in the living room where licensee can be visually observed through an open door if sleeping in a separate room. LPA reviewed individual Infant Sleeping Plan with licensee and understands it should be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. Licensee stated she currently uses the front yard for care and does not use the back yard. The back yard is made inaccessible by a rod iron fence. Licensee updated the facility sketch today and understands she is not to use the back yard until inspected by the Department. The front yard has a retractable fence that licensee encloses when the yard is being used for care. LPA inspected the front yard today and did not observe any hazards. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 1/2/2021. Licensee’s pediatric CPR/First Aid expires on 6/14/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for pertussis and measles. Licensee plans to take the flu immunization this year, she did not take the flu immunization last year. LPA explained that if she does not take the flu immunization, she should complete a yearly declination statement or save proof if she does take it.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.


SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 153803286
VISIT DATE: 09/10/2021
NARRATIVE
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LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D). Licensee was provided a copy of appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC809 (FAS) - (06/04)
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