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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700272
Report Date: 03/17/2026
Date Signed: 03/17/2026 12:00:23 PM

Document Has Been Signed on 03/17/2026 12:00 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
197700272
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, NANCYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 839-8941
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
03/17/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Nancy Hernandez, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On March 17, 2026, at 8:50 A.M., Licensing Program Analysts (LPAs) Joselito L. Del Mundo and Sara Rajapakse Montolla conducted an unannounced annual inspection at Hernandez Family Child Care Home to assess its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health, and Safety requirements. LPA met with the licensee, Nancy Hernandez. LPA Del Mundo stated the reason for the inspection. LPA was granted access to the facility. The LPA provided a copy of the LIC 126 Entrance Checklist Form to the licensee. The off-limits areas are bedrooms #2, #3, and garage.

The day care take place in the following areas of the home: living room #1 (main day care) and #2, bedroom #1, kitchen, dining area, bathroom #1, and side yard (left). Living room #2 will be used as a napping room. Licensee stated that bedroom #1 will be use for napping. Licensing fees are current.

Licensee states the day care hours of operation are Monday to Friday from 7:30 A.M. to 5:30 P.M. Currently living in the home is licensee, licensee’s spouse, and three minor children. During this visit, LPA observed five children present in the facility including the licensee’s child. At 9:21 A.M., one child was dropped off at the facility. At 9:25 A.M., licensee’s assistant arrived at the facility. Licensee showed a copy of the assistant’s LIC9163 Request for Live Scan Service. Licensee also stated that licensee’s assistant started on March 11, 2026. LPAs reviewed the LIC9163 and it was determined that the facility number is missing on the form. LPAs also check the Guardian Roster, and based on Guardian Roster, licensee’s assistant name is not shown on Guardian. Also, based on Guardian, there was an Action Required Letter dated March 13, 2026, for that licensee’s assistant which states that licensee’s assistant needs to provide additional information to CPMB on or before June 10, 2026. LPAs discussed the LIC9163 and the Action Required letter to the licensee, licensee’s spouse, and licensee’s assistant. At 9:57 A.M., licensee’s assistant left the facility.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700272
VISIT DATE: 03/17/2026
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Licensee was also reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

At 11:13 A.M., LPAs were notified by CPMB staff stating that licensee’s assistant was fingerprint cleared and licensee’s assistant was associated to the facility. During this visit, licensee's assistant was fingerprint cleared.

Physical Plant: The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. The smoke detector and carbon monoxide detector are in operable conditions (tested at 11:30 A.M.). The facility has a 2-A:10-B:C type of fire extinguisher. Per licensee, she owns no firearms, and no one smokes in the facility. LPAs observed cleaning products are stored inside the lower kitchen cabinets under the sink and in bathroom #1 and secured with child safety lock. Knives and other sharp items are stored inside the kitchen drawers next to the dishwasher and it has a child safety lock. LPAs also observed household medications are also stored in the upper kitchen cabinets. Per licensee, no medications are currently being provided to current children in care. Licensee stated that she is not a member of the food program, but licensee is providing meals and snacks.

The facility is a one-story house. There is a fireplace in living room #1 of the facility and is covered with a mesh screen and a glass door. Cubbies also blocked the fireplace. The home has central heating and air conditioning units.


LPA observed safe and age-appropriate toys, kitchen set toy, grocery set toy, puzzles, cubbies, tables, chairs, children’s books, colors, numbers, shapes, small couch, arts and crafts, and other age-appropriate toys. LPAs also observed three cribs, sleeping cots, diaper changing table, and a trash bin for soiled diapers in bedroom #1.
Licensee has first aid kit box located on the cubby underneath the parent board. LPA observed electrical outlets are covered with a safety plug to prevent access by children in care.
Bathroom: Toilet, sink, and faucet were clean and operable. LPA observed a step stool and trash bin with
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700272
VISIT DATE: 03/17/2026
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cover. LPA did not observe razors and/or sharp objects, medications, perfumes, air freshener, nail polish and nail remover that will pose a health and safety risk to children in care. During this visit, licensee removed the shampoos that were observed in the tub and stored the shampoos under the bathroom cabinet that has child safety lock.
Licensee stated that when a child shows signs of illness, the child is separated from other children either in the dining area or in the living room #1 of the facility and parents are called to pick up the child.
Outdoor: Licensee stated that there is no body of water on the premises. The facility has no body of water on the premises. The outdoor play area has age-appropriate toys and play equipment. The outdoor space is covered with turf. LPA observed small slides, toy cars, climbing and swinging rope. The outdoor play space was enclosed. LPA also observed 2 pets (dogs) at the backyard.
At the time of inspection, Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing on the day of the incident and/or 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report on unusual incident/injuries can also be emailed to unusualIncidentreport@dss.ca.gov
Review of records to be maintained: LPAs reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA reviewed six children’s files, licensee, and assistant’s files. Based on records review, the children’s files are complete. Licensee and assistant have current mandated reporter training and pediatric CPR/First Aid Training. Licensee and assistant have immunizations against Pertussis and Measles. Licensee and assistant have TB skin test on file.

Based on the facility roster, licensee has six children enrolled in the day care. Based on records review, fire/earthquake drills were conducted on February 17, 2026, at 11:20 A.M.



Licensee and the other adult living and working in the home have received criminal record clearance.

The following was discussed with the licensee:

The licensee was reminded that 100% supervision is required at all times to children in care. The licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed,

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700272
VISIT DATE: 03/17/2026
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licensing must be notified.

The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category. Licensee was advised to check for fixture, furniture and equipment that have been banned or recalled by the United States Consumer Product Safety Commission.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.


Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. Please log in to the CCLD website, or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700272
VISIT DATE: 03/17/2026
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The licensee was informed that the mandated reporter training must be completed every 2 years and is available at www.mandatedreporterca.com. New employees shall have 90 days from date of employment to complete training as required.

Prior to making alterations or additions to a family childcare home or grounds, the licensee shall notify the Department of the proposed changes, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "childcare" room; Room additions to the family childcare home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition, or construction.Lead Flyer Requirement Health and Safety Code 1596.7996 mandated that effective January 1, 2019, CCC's and FCCH's are required to provide parents and guardians of children enrolling or reenrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations, and options for locations of affordable blood lead tests as specified. A Lead Poisoning Facts Flyer was created, in partnership with the California Department of Public Health (CDPH), to satisfy this requirement. To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview the licensee, Nancy Hernandez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.


The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM to 5:00 PM. No deficiencies were cited at this time. An exit Interview and discussion of observations were conducted with the licensee.A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Nancy Hernandez.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
LIC809 (FAS) - (06/04)
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