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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700262
Report Date: 04/14/2022
Date Signed: 04/14/2022 09:05:56 AM


Document Has Been Signed on 04/14/2022 09:05 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:HERNANDEZ, WENDYFACILITY NUMBER:
015700262
ADMINISTRATOR:HERNANDEZ, WENDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 661-7553
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:14CENSUS: 2DATE:
04/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Wendy HernandezTIME COMPLETED:
09:30 AM
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On 4/14/2022, at 8:15 AM, Licensing Program Analyst (LPA) Elimika Woods met with licensee Wendy Hernandez for an unannounced Case Management Inspection for the purpose of adding an off limits area to on limits. Present for the inspection were two (2) school age children. The hours of operation are Monday-Friday 8:30 AM-5:00 PM.

Licensee requested to add the bedroom across from the bathroom to on-limits area for the purpose of being able to accommodated her new large family child care home. LPA conducted a health and safety inspection of the home inside and out. The new on-limit and off-limit areas are as follows:

The ON-LIMITS : Living and dining room, bathroom, bedroom (2), back and front yard, and bedroom (1) across the hallway from the bathroom


The OFF-LIMITS: Garage, and kitchen

The designated isolation area will bedroom (1) away from other children in care. The front yard/driveway will be a designated outdoor play area as well as a backyard and the licensee is aware she must have 100% visual and physical supervision when children are outdoors in the front yard area. The outdoor area has age appropriate toys and furnishings that LPA observed to be clean and free from defects and dangerous conditions.

LPA granted request to add bedroom (1) to on limits area as of 4/14/2022.

No deficiencies cited during today's inspection. Notice of site visit was given and must remain posted for 30 days. Exit interview conducted with licensee, Wendy Hernandez.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022
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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