Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624066
Report Date: 11/15/2016
Date Signed 11/15/2016 01:54:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:FLORES, LENIKA & HERNANDEZ, KARINA FAMILY CHILD CAFACILITY NUMBER:
376624066
ADMINISTRATOR:FLORES,LENIKA & HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 426-1513
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:14CENSUS: 12DATE:
11/15/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Karina Hernandez TIME COMPLETED:
02:05 PM
NARRATIVE
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(1)LPA Celina Damian made an unannounced Annual/Random visit and met with Licensee Karina Hernandez. There were 12 children in care. There was also an additional adult present assisting as well as two student volunteers. Facility is within ratio and capacity. Licensee Lenika Flores arrived shortly thereafter. After some discussion with Licensee Flores it was found that one of the student volunteers is also a paid part time assistant and was hired to work in facility effective 10/2016. Her student hours are M/W 9-12PM and her working hours are M/T 9-1PM and Thurs 9-5PM. This individual has not obtained proper fingerprint clearance as required by Department. A Type A deficiency and civil penalty will be issued.

Licensee is using the following areas for daycare: Living rooom, family room, dining room, kitchen, children's bedroom and one bathroom. Off-limits areas include: Two bedrooms and master bathroom. During inspection of the home it was found that Licensee Karina Hernandez no longer resides in the home. Licensee states she forgot to notify Department.

LPA inspected the home and found that all cleaners, toxins, medications and other hazardous substances are inaccessible to children in care and are located in off limits area. Licensee has provided adequate space for the children to eat, sleep and play within the home. Home is clean, orderly and has adequate ventilation. Children’s toys and play equipment is safe and age appropriate. Primary telephone is a land line which is operational. There are no firearms or other weapons in the home. Fire extinguisher, smoke detector and carbon monoxide detector are operational. Last fire drill was conducted on 07/15/2016. Licensee does not have facility license posted and license is not available. There are no existing bodies of water present. Outdoor play area is fenced yard which is free of hazardous items. There are no pets at facility. Children records were reviewed for Emergency Information. Pediatric CPR and First-Aid certificates are valid. Licensee and other employees do not have required immunizations.
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Celina DamianTELEPHONE: 619-767-2200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: FLORES, LENIKA & HERNANDEZ, KARINA FAMILY CHILD CA
FACILITY NUMBER: 376624066
VISIT DATE: 11/15/2016
NARRATIVE
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LPA reviewed the following: required departmental documents, clearances, child passenger law, unusual incidents and reporting requirements.

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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

AB633****Deficiencies are cited on LIC 809D. LPA discussed appeal rights with Licensee. Notice of Site Visit was posted during visit and must remain posted for 30 Days. Furthermore, upon receipt, Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. An Acknowledgment of Receipt of Licensing Reports, Form LIC 9224 must be signed and placed in each child’s file. Exit interview conducted with licensee.

A civil penalty has been assessed for one or more citation listed on this report.

SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Celina DamianTELEPHONE: 619-767-2200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2016
LIC809 (FAS) - (06/04)
Page: 2 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: FLORES, LENIKA & HERNANDEZ, KARINA FAMILY CHILD CA
FACILITY NUMBER: 376624066
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/25/2016
Section Cited
102352(h)
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102352(h)"Home" means the licensee's residence as defined by Government Code Section 244.
Licensee Karina Hernandez moved out of home eight months ago. Department was not notified.
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Licensee Flores will fill out an updated LIC 279 and will remove Karina Hernandez from license. Licensee Flores was reminded that she must be present 80 percent of time to provide daycare and that a colicensee must hold primary residence at facility. She states she understands requirement.
Type B
12/02/2016
Section Cited
102368(a)
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102368(a) The license shall be available in the facility upon request.
License is not posted and is not available.
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Once LIC 279 is processed by LPA a new and updated license will be mailed to facility. The license must be posted at all times and available upon request. Licensee Flores states she understands.
Type B
12/15/2016
Section Cited
H&S 1597.622
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H&S 1597.622- 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. Licensees, assistants and student volunteer does not have required pertussis, measles immunization and flu vaccine or exemption as required.
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Licensee and all other required individuals will obtain immunization and will maintain proper documentation as required. Proof of immunization will be provided to LPA by 12/15/2016.
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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: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Celina DamianTELEPHONE: 619-767-2200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2016
LIC809 (FAS) - (06/04)
Page: 4 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: FLORES, LENIKA & HERNANDEZ, KARINA FAMILY CHILD CA
FACILITY NUMBER: 376624066
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
11/16/2016
Section Cited
102370(d)(1)
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All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department. Jessica Auna has been working as a part time assistant
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Ms. Auna will not work at facility unitl her fingerprints cleared through DOJ (Department of and CACI (Child Abuse Child Index). Ms. Auna may only volunteer Monday and Wednesday from hours of 9AM-12PM. This work may not be paid. Additionally, Licensee Flores must be supervising her at all times, Ms. Auna may
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since 10/2016. Ms. Auna submitted fingerprints on 10/13/2016 but has not received fingerprint clearance as required by Department.
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not be left alone with children and may not volunteer for more than 16 hours a week. Any changes to volunteer hours must be reported to LPA until proper fingerprint clearance is obtained. Failure to comply will result in $100 civil penalty per each day Ms. Auna works at facility outside of volunteer hours.
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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: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Celina DamianTELEPHONE: 619-767-2200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2016
LIC809 (FAS) - (06/04)
Page: 3 of 4