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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004674
Report Date: 06/03/2022
Date Signed: 06/03/2022 04:12:33 PM


Document Has Been Signed on 06/03/2022 04:12 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:HERNANDEZ,MARILU V.FACILITY NUMBER:
414004674
ADMINISTRATOR:HERNANDEZ, MARILU V.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 773-8427
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:14CENSUS: 8DATE:
06/03/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Licensee, Marilu HernandezTIME COMPLETED:
01:00 PM
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On June 3rd, 2022 at 12:35pm, Licensing Program Analyst (LPA) Tapia-Mandujano met with licensee, Marilu Hernandez and conducted a Plan of Correction (POC) inspection. Purpose of inspection was explained and was an unannounced, plan of correction inspection. Present in the facility are Licensee and assistant caring for 8 children (4 infants and 4 preschool age). All adults living and working in the facility are fingerprint cleared and associated. LPA inspected for Health and Safety Hazards.

On 5/18/2022, licensee was cited under Tittle 22 Division 12 CCR:102370(d)(1), as there was an uncleared adult caring for children. Per interview, licensee stated that she will ensure all adults are fingerprint cleared and associated prior to being present with children.

During today's inspection, LPA observed that the two adult present are fingerprint cleared and associated.

Deficiency issued on 5/18/2022, was cleared and ‘Cleared Plan of Correction Letter’ was provided to Licensee.

Based on today's inspection, no deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with Licensee, Marilu Hernandez.

This report must be available in the facility for public review. Notice was provided and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2022
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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