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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376620714
Report Date: 08/11/2022
Date Signed: 08/11/2022 12:55:04 PM


Document Has Been Signed on 08/11/2022 12:55 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:HERNANDEZ, MARTHA & JOSE FAMILY CHILD CAREFACILITY NUMBER:
376620714
ADMINISTRATOR:MARTHA & JOSE HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 850-3610
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY:14CENSUS: 9DATE:
08/11/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Martha and Jose HernandezTIME COMPLETED:
12:30 PM
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On August 11th, 2022 at 12:10 PM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted an unannounced Annual Required Inspection and met with the Licensee Jose Hernandez. LPA disclosed the purpose of the inspection and was granted facility entry by the Licensee. The Licensees, two (2) helpers and nine (9) children were present in the daycare during the inspection; three (3) children were infants and the remaining children were school aged.

On 07/25/2022, the Licensees submitted an application (LIC 279) requesting to add a previously covered patio room for use in the facility; this room is referred to by the Licensees as the “California Room”. The “California Room” also has its own enclosed bathroom. The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal on 08/09/2022 for use of the “California Room” and its enclosed bathroom.

This facility is a five (5) bedroom, four (4) bathroom house. Licensee accompanied LPA during this inspection. The following areas used for childcare are: living room, dining room/kitchen, one (1) bedroom, one (1) bathroom, shaded and fenced backyard and fenced front yard. The off limit areas are the remaining bedrooms and bathroom, which are made inaccessible using door locks and a safety gate barring entrance into the hallway of these rooms.

Licensees accompanied LPA on a tour of the home and the “California Room”, as shown on the updated facility sketch. Background criminal record clearances were verified and discussed. First Aid and CPR certifications expire in June 2023. Facility has working 2A10BC fire extinguisher, smoke alarms, carbon monoxide detector, and the first aid kit in place. The last safety drill was on 07/25/2022. There are no bodies of water on the premises. Per the Licensee, no weapons or ammunition are housed in the facility. The daycare schedule is weekdays 5 AM to 7 PM.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022
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 2


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: HERNANDEZ, MARTHA & JOSE FAMILY CHILD CARE
FACILITY NUMBER: 376620714
VISIT DATE: 08/11/2022
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In the areas that were evaluated, the “California Room” and its enclosed bathroom, no deficiencies were observed. Use of the “California Room” and its enclosed bathroom are approved effective today (08/11/2022).

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Licensees Martha and Jose Hernandez.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC809 (FAS) - (06/04)
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