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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312394
Report Date: 01/31/2023
Date Signed: 01/31/2023 03:04:20 PM


Document Has Been Signed on 01/31/2023 03:04 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:HERNANDEZ, ASCBETH ESPERANZAFACILITY NUMBER:
304312394
ADMINISTRATOR:HERNANDEZ, ASCBETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 415-9125
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY:14CENSUS: 2DATE:
01/31/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Licensee, Ascbeth Esperanza Hernandez TIME COMPLETED:
03:30 PM
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A case management inspection was conducted today by Licensing Program Analysts (LPAs), Dianna Valdez Santana and Aiddee Nunez who met with the Licensee, Ascbeth Esperanza Hernandez . Present today was the Licensee and 2 children. A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

According to a self-reported incident on 1/24/23 by the facility, they were visited by 6 police officers at 1pm on 01/24/23. Present at that time was the licensee, an assistant and the licensee’s spouse arrived soon after. During the Anaheim police officers’ visit there were 6 children present. Officers requested the two older children (4 year olds) be woken up during their nap so they can be interviewed.

On 1/31/23, LPAs inquired about the officer in charge and a police report incident number. Licensee stated, they did not provide a case number to her at the time of visit but would provide the case number and the officer in charge. Licensee called the police department to inquire about the case number, there was no answer, she left a voicemail.

In the areas that were evaluated, the facility was in compliance with the California Code of Regulations, Title 22, Division 12. During today’s visit, LPAs obtained an updated copy of the LIC9040, Children’s Roster. and licensee will provide LPAs will assigned police report incident number.

Exit interview was conducted with licensee, Ascbeth Esperanza Hernandez. The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The Licensee was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.

End of Report.

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Dianna ValdezSantanaTELEPHONE: 714-292-8628
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2023
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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