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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700262
Report Date: 02/11/2022
Date Signed: 02/11/2022 10:01:56 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HERNANDEZ, WENDYFACILITY NUMBER:
015700262
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
02/11/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Wendy HernandezTIME COMPLETED:
10:25 AM
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On February 11, 2022 at approximately 09:00 AM, Licensing Program Analyst (LPA) Elimika Woods met with Licensee Wendy Hernandez for an ANNOUNCED CASE MANAGEMENT CAPACITY INCREASE INSPECTION. Present for this visit was licensee's fingerprint cleared associates V. Androsenke, S. Molinar, and four (4) children, one (1) infant and three (3) preschool age children. The home was toured to conduct a Health and Safety Inspection.

On-limit-areas include: Living and dining room, bathroom, bedroom (1), backyard, front yard

Off-limit-areas include: bedroom (2) across from bathroom, garage, and kitchen

This one story home which consists of two bedrooms, one bath, kitchen, garage, backyard, living and dining room. The home is neat and clean with heating and ventilation for safety and comfort. The ISOLATION AREA will be the dining room away from children in care. The off-limit area will be inaccessible by child safety gates, closed and/or locked doors and visual supervision.

The outdoor play area is the fully fenced backyard and LPA observed that it is free from defects or dangerous conditions. The front yard is also used for play , and the licensee is reminded to have 100% visual supervision since the outdoors is unfenced. There are no changes to the home since the last inspection visit on 07/27/2021.

A fire clearance for 14 was approved on 1/04/2022. LPA reviewed the application prior to this visit and the home has an approved fire clearance from the Alameda County Fire Department. The facility currently plans to operate 8:30 AM until 5:30 PM., Monday through Friday

There are no deficiencies cited today. Notice of Site visit was provided to the licensee to be posted for the next 30 days. Exit interview conducted and report was reviewed with the licensee, Wendy Hernandez. .

Based on the approval of the fire clearance, issuance of license is recommended for this home effective today. Licensee is approved for the Change of Capacity as of 02/11/2022.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
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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