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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414408
Report Date: 03/03/2025
Date Signed: 03/03/2025 08:49:01 AM

Document Has Been Signed on 03/03/2025 08:49 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: 0DATE:
03/03/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Licensee Sylvia HernandezTIME VISIT/
INSPECTION COMPLETED:
08:55 AM
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On 3/3/25 at 8:15 AM, Licensing Program Analyst (LPA) Jeanine Lipsey conducted an unannounced case management visit for the purpose of obtaining signatures and delivering an amended report LIC 9099 created on 2/26/25. LPA met with, Licensee Sylvia Hernandez and toured the facility. Census was zero.



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: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2025
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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