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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700243
Report Date: 02/10/2022
Date Signed: 02/11/2022 01:07:20 PM

Document Has Been Signed on 02/11/2022 01:07 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:SERMENO FAMILY CHILD CAREFACILITY NUMBER:
197700243
ADMINISTRATOR:SERMENO, SANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 789-8742
CITY:LITTLEROCKSTATE: CAZIP CODE:
93543
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 3DATE:
02/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:13 AM
MET WITH:Sandra SermenoTIME COMPLETED:
11:40 AM
NARRATIVE
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On 2/10/2022, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Required 1 Year inspection at the Sermeno Family Child Care. Upon arrival, the LPA met with the licensee, Sandra Sermeno who guided the LPA on a tour of the facility. Family members residing in the home Family members residing in the home include one adult (Licensee) and no children. Per LIS, facility annual fees are current. All adults living in the home have been background cleared. Per licensee, the hours of operation are Days/hours of operation will be Monday through Friday from 6AM to 5:30 PM. Incidental Medical Services (IMS) policy was discussed. There were 3 daycare children present during this inspection.

The Home is set up as follows:
This is a one-story home with 3 bedrooms and 2 bathrooms, living room, dining room, kitchen, screened fireplace, attached garage, backyard. This home has central Air and Heat. There is no pool, spa, or other bodies of water on the premises. The home was inspected for safety, comfort, cleanliness, telephone service, central air, and heat and ventilation. The home has central heating and air conditioning. All windows have screens and are free of cracks, bugs, and debris. Hanging window blind cords are inaccessible to children.

Ø Main Area: Main care is provided in the Living room, Bedrooms #1 and #3. Children use the bathroom down the hall to the right.
· Living Room: In the Living room, LPA observed a fireplace that was properly screened via a mirror glass barrier which made it inaccessible to children with storage unit. LPA observed age-appropriate toys and furniture for the children. Three small tables were observed with a total of eight chairs. Several plastic storage bins were observed in which games and toys are stored for the children. A small play kitchen was located by the door with which children can play. There are games and books on the premises of this facility. LPA observed age-appropriate furniture and toys in the room.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 02/11/2022 01:07 PM - It Cannot Be Edited


Created By: Carol Heath On 02/10/2022 at 10:23 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SERMENO FAMILY CHILD CARE
FACILITY NUMBER: 197700243

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. LPA observed blanckets, toys hanging or insde the crib. During the inspection, LPA advised the Licensee to remove all the objects during the inspection. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/10/2022
Plan of Correction
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LPA shared Safe Sleep regulation with the licensee. She will read and mantain the safe sleep regulation
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. The licensee was unable to provide the sleeping log for checking infant 10-15 minints,] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/10/2022
Plan of Correction
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On 2/10/2022, The licensee will start logging and checking the infant (0-12 months) every 10-15 minitus.
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:Claretta Yates
LICENSING EVALUATOR NAME:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2022


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Document Has Been Signed on 02/11/2022 01:07 PM - It Cannot Be Edited


Created By: Carol Heath On 02/10/2022 at 10:23 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SERMENO FAMILY CHILD CARE
FACILITY NUMBER: 197700243

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. During the inspection, the licensee was able to provider her assistant's personnel records sush as , LIC 9052 , LIC 9108, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/18/2022
Plan of Correction
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The licensee will ask her assistant to provide and sign all the requirement documentation. The assistant will NOT attend the facility until she provide all the documentation.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited aboveh. The licensee was unabe to provide assisstant's IZ(MMR, DTP, TB). which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/18/2022
Plan of Correction
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The licensee will email her assistant's MMR, DTP and TB shot record by 2/18/2022.
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:Claretta Yates
LICENSING EVALUATOR NAME:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2022


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Page: 2 of 12
Document Has Been Signed on 02/11/2022 01:07 PM - It Cannot Be Edited


Created By: Carol Heath On 02/10/2022 at 10:23 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SERMENO FAMILY CHILD CARE
FACILITY NUMBER: 197700243

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. LPA observed 7 children's file. All children do not have BLUE IZ Card in the file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/18/2022
Plan of Correction
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The licensee will fill out all the Blue IZ Card and email to LPA by 2/18/2022
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. During today's inspection, LPA did not observed any Individual Infant Sleeping Plan (LIC 9227) in child's file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/18/2022
Plan of Correction
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The licensee will fill out LIC 9227) with infant's parent and email LPA the paperwork.
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:Claretta Yates
LICENSING EVALUATOR NAME:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2022


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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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SERMENO FAMILY CHILD CARE
FACILITY NUMBER: 197700243
VISIT DATE: 02/10/2022
NARRATIVE
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· Children Bathroom (#1): Children use the bathroom in the hallway on the right. The Bathroom was toured, and inspected sink/toilet is in operable condition. Toilet and faucets are clean, safe, and operable. All poison and medications are made inaccessible to children with child safety latches on the sink cabinet and drawers. The bathroom was observed to be free and clear of hazardous items. The bathroom was clean, sanitized, and in good repair.
· Bedroom #1 (young children napping room): LPA observed 5 cots, table and storage bins with toys. Per licensee, the young children are napping in this room.
· Bedroom #2 (Infant napping room): LPA observed 3 cribs. Inside the cribs, there are toys hanging, bumpers around the cribs, Blanket and bouncing chair. LPA also asked the licensee for the sleeping log. The licensee was unable to provide the log. Pre licensee, she did not know she needs to document every 10-15 minutes. During the inspection, LPA advised the licensee to remove any objects hanging on the cribs.
· Backyard: The backyard was inspected; The property's backyard is separated into two sections. The area of the backyard used for childcare is fenced (wood) and gated. This play area is clear and clean of debris. There are age-appropriate toys on the patio. There is a covered patio section for children to play.
The rear section is currently off-limits due to the current construction of a swing set that will have a gazebo for shade. This gate (patio area) remains locked as to not allow children access to the off-limits rear area. There is also a dog run area and a large metal shed (double locked) off-limits.
The backyard is gated all around. The outdoor play area was observed to be free of hazards, loose and sharp parts.
Ø Off-limit: The areas include the kitchen (gated), master bathroom and the garage (key lock observed).
· Kitchen/Dining Room: The kitchen is off-limits (safety gate). Sharp items (knives), medication, and chemicals are located in the upper cabinet and are inaccessible. The kitchen was inspected to ensure hazardous items were inaccessible to children (Safety latches). In the kitchen, all sharp utensils, poisons, and medications are made inaccessible to children with child safety latches on cabinet doors and drawers. Sharp knives are kept in a butcher block in the gated kitchen.

Ø Others:
· AC/Heating Unit was observed. AC/Heating Unit is located on the roof of the home is inaccessible to children.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
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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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SERMENO FAMILY CHILD CARE
FACILITY NUMBER: 197700243
VISIT DATE: 02/10/2022
NARRATIVE
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· Bodies of water: Per licensee, there are no bodies of water in the home.
· Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
· Fire extinguisher (2A10BC): LPA observed there is a required fire extinguisher (2A10BC) fully charged Date: 3/7/2021 (receipt) and located in the kitchen inaccessible to children.
· Fireplace: The fireplace was observed in the living room with storage unit which made it inaccessible to the children
· Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The Licensee will not be providing IMS to the children at this time.
· Medications and cleaning solutions: Detergents/cleaning compounds are under the kitchen sink with a child locked. Medications are in the off-limits bedroom.
· Napping: Children will nap in the designated nap areas (Bedroom 1 and Bedroom 3) with adult supervision. LPA observed 5 mats and 3 cribs in the bedroom 1 and 3.
· Phone service: There is a working landline or cell phone
· Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested operable.
· The First Aid kit is located in the hallway closet inaccessible to children. The First Aid Kit was observed complete with supplies and a first aid manual.
· Transportation: The licensee will not transport daycare children.
· Weapons or Firearms: Per licensee, there are no weapons or firearms. LPA did not observe any weapons or firearms.

Ø Documentation:
· Child files: LPA reviewed 7 children's records, the records are incomplete and missing forms. In all children’s files, the licensee did not fill out Blue IZ cards and some papers are missing information.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
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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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SERMENO FAMILY CHILD CARE
FACILITY NUMBER: 197700243
VISIT DATE: 02/10/2022
NARRATIVE
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· CPR/First Aid: LPA observed licensee has current Pediatric CPR and First Aid Training with expiration date (09/2021) 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.
· Facility Roster: LPA observed Child Care, Facility Roster. Per Licensing Information System, facility annual fees were current.
· Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 01/03/2021.
· Immunization: The licensee has the required immunizations. The licensee provided a written statement declining the influenza vaccination. The licensee was unable to provide her assistant’s Immunization record.
· Licensee has posted as required the Facility License, Emergency Disaster plan, and Parents Rights Poster.
· Mandated Reporter Training: The licensee has completed the online mandated reporter training at www.mandatedreporterca.com, and will renew 4/28/2023 and her assistant Maria Zuniga will renew 1/14/2024.
· Staff File: LPA asked Maria Zuniga’s file. The licensee was unable to provide assistant #1’s MMR, DTP and TB shot and other requirement paperwork.

Ø The following information was discussed with the licensee:
ü Mandatory Forms for the children’s files and provider’s files.
ü Requirements for fire drills, earthquake drills, and documentation for both.
ü The role and responsibilities of being a mandated reporter were discussed.
ü The licensee is reminded that 100% supervision is required for children at all
times.
ü Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
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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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SERMENO FAMILY CHILD CARE
FACILITY NUMBER: 197700243
VISIT DATE: 02/10/2022
NARRATIVE
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ü Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.
ü Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
ü The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
ü Criminal Record Statement: Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to the initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
ü Safe Sleep: LPA discussed the safe sleep regulations with licensee [or facility representative] 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 licensee [facility representative] 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.
ü Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.
ü Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
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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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SERMENO FAMILY CHILD CARE
FACILITY NUMBER: 197700243
VISIT DATE: 02/10/2022
NARRATIVE
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ü Type A citation: LPA (name of analyst) informed licensee [or facility representative] (include name) that this report dated (insert visit date) document(s) (number of Type A citation) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA (name of analyst) informed the licensee [or facility representative] to provide a copy of this licensing report dated (insert visit date) that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
ü The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.
ü --Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
n Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: [email protected]

ü The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.

ü A copy of the Safe Sleep Proposed Regulations was provided to Licensee.

ü LPA provided consultation during the inspection.

Deficiencies cited: (See LIC 809D). The following Type B deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.



Exit interview conducted and the report was reviewed with the licensee Sandra Sermeno

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
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