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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414408
Report Date: 02/26/2025
Date Signed: 02/26/2025 11:23:57 AM

Document Has Been Signed on 02/26/2025 11:23 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
197414408
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, SYLVIA J.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 465-3733
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
02/26/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Licensee Sylvia HernandezTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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On 2/26/25, at 9:35AM, Licensing Program Analyst (LPA) Jeanine Lipsey conducted an unannounced Plan of Correction (POC) Visit. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee Sylvia Hernandez, who guided the LPA on a tour of the facility. There were four children present being supervised by Licensee and her daughter. During the Required - 3 Year inspection conducted on 1/27/25, the following deficiencies were issued:

1. The mesh fencing is not attached to the wall to prevent a child from entering. The door does not self lock or close. POC CLEAR
2. Must have a pool cover or alarm, licensee has an alarm, LPA was able hear the alarm sound when the water was disturbed. POC CLEAR
3. 17' US coast guard life ring, licensee purchased the incorrect life ring, the correct life ring was purchased today 2/26/25 NOT CLEAR
4. 12 foot rescue pole with body hook. 12 foot pole present, Body hook ordered due to come 2/26-2/28/25. NOT CLEAR
5. Daily inspection of drowning prevention safety features, POC CLEAR
6. All items must have documentation from the American Society for Testing and Materials (ASTM) international standards POC CLEAR
7.Gap between the wall and the mesh fencing that a child can fit through. POC CLEAR

Correction still needed: Licensee will send photo proof once the body hook and US Coast Guard life ring arrives.

Exit interview conducted and report was reviewed with Licensee Sylvia Hernandez. Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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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