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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310480
Report Date: 07/11/2019
Date Signed: 07/11/2019 08:39:53 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:HERNANDEZ, IRMAFACILITY NUMBER:
304310480
ADMINISTRATOR:HERNANDEZ, IRMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 691-1348
CITY:LAHABRASTATE: CAZIP CODE:
90631
CAPACITY:14CENSUS: 7DATE:
07/11/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Irma Hernandez, LicenseeTIME COMPLETED:
08:30 AM
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Licensing Program Analyst (LPA) Yesenia Villa arrived at the facility for the purpose of a case management visit. LPA Villa was unable to leave the Licensee copies of the full report on her visit conducted 07/10/19 due to computer issues.

LPA Villa was greeted by Irma Hernandez, Licensee, also present during today's visit was assistant Yurixi Estrada. Census was obtained there were seven children present during today's visit. All personnel present have obtained a criminal background clearance prior to residing in the home. Facility was observed to be within ratio and capacity.


No citations were issued during today's inspection.


A notice of site visit was issued and Licensee Irma Hernandez was informed failure to post for 30 days will result in a $100.00 civil penalty fee. An exit interview was conducted with Licensee Irma Hernandez and appeal rights were issued and explained.


Page 1 of 1 end of report.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
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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