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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492985
Report Date: 06/03/2022
Date Signed: 06/03/2022 08:07:15 AM

Document Has Been Signed on 06/03/2022 08:07 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
197492985
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/03/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
07:59 AM
MET WITH:Delores HernandezTIME COMPLETED:
08:00 AM
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On 6/3/2022, Licensing Program Analyst (LPA) Carol Heath conducted an announced in-person inspection to the Hernandez Family Child Care Home. LPA met with Licensee Dolores Hernandez. The purpose of the inspection is to conduct a follow-up Pre-Licensing Inspection to review the corrections required for licensure. LPA and Licensee toured the facility inside and out to ensure the home meets State Licensing Title 22 Regulations.

The following corrections were observed during the time of this inspection:

o The licensee’s assistant completed her live scan process and the fingerprints
have been cleared
o The licensee made the windows cords inaccessible to the children
o The licensee repaired the backyard fence.


***As a result of this inspection, the home does meet Title 22 Regulations. The applicant is ready for licensure pending the manager's approval.

The exit interview was conducted and the report was emailed and reviewed with the applicant Dolores Hernandez.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
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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