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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700450
Report Date: 09/19/2024
Date Signed: 09/19/2024 03:39:10 PM

Document Has Been Signed on 09/19/2024 03:39 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:FERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
197700450
ADMINISTRATOR/
DIRECTOR:		BLANCA FERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 964-7262
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
09/19/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Blanca FernandezTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On 9/19/2024, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced annual/random inspection at Fernandez Family Child Care. Upon arrival, LPA Heath met with the licensee, Blanca Fernandez, who provided a facility tour. One adult (the licensee) and two children (13 and 17 years old) occupy the home. 2 young children and one infant (1 year old) were present at the time of the inspection. The licensee stated that the facility operates Monday through Friday, from 6:00 a.m. to 6:00 p.m. Incidental Medical Services (IMS) were discussed, and the licensee confirmed that no children require IMS.
The home is set up as follows:
The home is a one-story house featuring three bedrooms, two and a half bathrooms, and a kitchen/dining room, laundry room, and garage. No pool, spa, or body of water is on the premises. The home was inspected for safety, comfort, cleanliness, telephone service, and ventilation. It has central heating and air conditioning, and all windows have screens free of cracks, bugs, and debris.
Daycare is provided in the family room and living room. Children use the bathroom in the hallway on the left. Children have access to the living room and family room.
Off-limit areas include all bedrooms, bathrooms #1 and #2, kitchen, laundry room, and garage. LPAs observed a barricaded gate in the hallway, making all bedrooms, bathroom #1.5, laundry room, and garage inaccessible to children in care. LPAs also observed two safety gates on each side of the kitchen entrances to be barricaded.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 12
Document Has Been Signed on 09/19/2024 03:39 PM - It Cannot Be Edited


Created By: Carol Heath On 09/19/2024 at 02:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(f)
Infant Safe Sleep
An infant shall not be swaddled while in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. During today's inspection, LPA observed a one-year-old infant sleeping in a room with the door closed. The infant was swaddled and placed inside a crib. which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2024
Plan of Correction
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LPA instructed the licensee to remove the blanket and unswaddle the infant. LPA also provided Safey Sleeping regulations. The licensee will follow the regulations when the infant is in care.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024


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Document Has Been Signed on 09/19/2024 03:39 PM - It Cannot Be Edited


Created By: Carol Heath On 09/19/2024 at 02:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation,interview and record review, the licensee did not comply with the section cited above. There is a infant during today's inspection. However, there are 2 other children were inrollment whent they were under 2 year old. The licensee was unable to provide their sleeping log, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2024
Plan of Correction
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The licensee will begin monitoring and logging infant sleep patterns until the child reaches 24 months of age. The licensee agrees to email one week of the sleep log to the LPA for review and retain the log in the child's file for three years.
Type B
Section Cited
CCR
102425(j)(5)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed a one year old infant was sleeping in the office area with the door closed and there was no staff inside with the infant, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2024
Plan of Correction
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LPA provided the safe sleep regulations. The licensee understands that the door will remain open while the child is sleeping inside.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024


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Page: 3 of 12
Document Has Been Signed on 09/19/2024 03:39 PM - It Cannot Be Edited


Created By: Carol Heath On 09/19/2024 at 02:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above. There is a infant during today's inspection. However, there are 2 other children were inrollment whent they were under 1 year old. The licensee was unable to provide their Individual infant sleeping plan (LIC9227), which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2024
Plan of Correction
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The licensee will have the infant parents fill out LIC 9227. The licensee will put the Individual Infant Sleeping Plan (LIC 9227) in the enrollment package.
Section Cited
Infant Safe Sleep
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024


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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450
VISIT DATE: 09/19/2024
NARRATIVE
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Family/ Living Room/office(infant sleeping room): Family/Living Room/Office (Infant Sleeping Room): The designated family and living rooms are equipped with age-appropriate toys, books, games, and napping mats, along with hygienic diaper-changing equipment. LPA observed toys and furniture suitable for the children and various games and books available on the premises. The carpets and other materials were found to be in good condition. LPA also observed a one-year-old infant sleeping in the office with a closed door. The infant was swaddled while sleeping. Two bookshelves will need to be secured to the wall for earthquake safety.
Children's bathroom: Children will use the bathroom down the hall to the left. The bathroom was the tour. The bathroom was clean, sanitized, and in good repair. The toilet was inspected, and the sink/toilet is in operable condition. The toilet and faucets are clean, safe, and operable. The bathroom was observed to be free and clear of hazardous items.
Kitchen/Dining Room: The kitchen was inspected to ensure dangerous items were inaccessible to children (Safety latches). All sharp utensils, poisons, and medications are unavailable to children in the kitchen, with child safety latches on cabinet doors and drawers. Sharp knives are kept in a butcher block in the gated kitchen.
Backyard: The backyard, used by the children for outdoor play, was inspected and is fully gated. The outdoor play area was free of hazards, loose parts, and sharp objects. A body of water (spa) is on the house's left side. LPA observed a hanging wire, a toy leaning against the wall, and a dog cage placed against the pool gate. LPA advised the licensee to remove the toy and dog cage to prevent children from using them to climb.
Others:
AC/Heating Unit and Swamp Cooler Unit: The AC/Heating Unit, located on the right side of the home, is inaccessible to children due to barrels blocking access.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450
VISIT DATE: 09/19/2024
NARRATIVE
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Bodies of Water: According to the licensee, there are bodies of water in the home. Spa/Hot Tub: the fencing would be constructed at least five feet high, with the bottom of the fence no more than two to four inches from the ground. The fence is designed to prevent climbing, has gates that swing away from the pool, self-close, and a self-latching device no more than six inches from the top. The licensee agrees to maintain the pool fencing in compliance with licensing requirements to ensure the pool remains inaccessible to children.
Electrical Outlets: All unused electrical outlets are covered and inaccessible to children.
Fire Extinguisher (2A10BC): A fire extinguisher rated 2A10BC, reading in the green zone, is located in the kitchen and is inaccessible to children. It meets the standards set by the State Fire Marshal.
Fireplace: The fireplace in the family room is properly screened with mirrored glass doors and is inaccessible to children.
Hanging Window Blind Cords: Cords are kept out of reach of children.
Isolation Area (Illness): If a child shows signs of illness, they will be separated from other children.
Medications and Cleaning Solutions: Detergents and cleaning compounds are stored in an upper kitchen cabinet, while medications are kept in an off-limits bedroom.
Napping: Children nap in designated areas with adult supervision. Ten mats were observed in the closet for napping.
Overnight Care: The licensee does not provide overnight care.
Pets: Two small dogs in the dining room and bedroom area, all with current vaccinations, live in the house.
Phone Service: A working landline or cell phone is available.
Smoke Detectors and Carbon Monoxide Detectors: Both smoke and carbon monoxide detectors were tested and are operational.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450
VISIT DATE: 09/19/2024
NARRATIVE
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First Aid Kit: The first aid kit is stored in a key-locked closet and includes supplies and a first aid manual.
Transportation: The licensee does not provide transportation for children and holds a valid California driver’s license, valid vehicle insurance, and current vehicle registration.
Weapons or Firearms: Per the licensee, there are No Firearms at the facility at this time. LPA does not observe any firearms.
Documentation:
Child files: LPA observed four children's files contained all required licensing documents.
Infant Sleeping Plan (LIC 9227) and Sleeping Log: LPA observed 2 infants. Both infants do not have LIC 9227, and there are no sleeping logs in their files.
Staff Personnel File: LPA observed 1 staff information. LPA observed LIC 508, 9052, IZ, TB test, LIC 9108, Mandated Reporter Training, and CPR/First Aid certificates. The file contained all required licensing documents.
Immunization: The licensee and her assistant have the required immunizations (MMR and DTaP). They also provided a written statement declining the influenza vaccination.
Criminal Record: Per Guardian, all adults who live in this facility obtain a criminal record clearance.
CPR/First Aid: LPA observed that the licensee has current Pediatric CPR and First Aid Training with an expiration date (of 08/2024) 1 hour of nutrition training and (8) hours of Preventive Health and Safety Training.
Mandated Reporter Training: The licensee has completed and renewed the online mandated reporter training at www.mandatedreporterca.com on 10/17/2022. LPA reminded the licensee to renew the training next month.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450
VISIT DATE: 09/19/2024
NARRATIVE
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Facility fees: Per the Licensing Information System, annual facility fees were current.
Fire Drill and Disaster Drill: Per the licensee, fire, and disaster drills are conducted every 6 months; the last drill was documented and conducted on 2/15/2024. The facility does not have current facility earthquake/fire drill documents during this inspection.
LPA observed that the licensee post the Facility License, Emergency Disaster plan, Earthquake Preparedness, and Parents' Rights Poster as required.
The following information was discussed with the licensee:
o A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code sections 1596.848(b) and (c). State law prohibits baby walkers, bouncy seats, exersaucer, and other items that fall into that category.
o Capacity requirements, Roster requirements, Posting requirements, and Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children's and provider's files and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
o The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
o Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility's phone number; if the phone number is changed, licensing must be notified.
o Mandatory Forms for the children's files and provider's files.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450
VISIT DATE: 09/19/2024
NARRATIVE
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o Our Quarterly updates come out every 3 months. They are also now in Spanish. 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
o Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
o Requirements for fire drills, earthquake drills, and documentation for both.
o The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.
o The licensee is reminded that 100% supervision is required for children at all times.
o The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
o 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 childcare home where children are present (24/7 ban).
ü LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [or facility representative] 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450
VISIT DATE: 09/19/2024
NARRATIVE
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ü Licensee [or facility representative] 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.
ü IF THERE IS NO CHILD AT THE FACILITY THAT CURRENTLY NEEDS IMS, USE AS FOLLOWS: 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/.
ü Centers and Family Child Care Homes Licensee [or facility representative] 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.
ü Family Child Care Homes During the exit interview, the LICENSEE ****, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
ü Family Child Care Homes A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700450
VISIT DATE: 09/19/2024
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ü 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-carelicensing/ inspection-process.

Deficiencies cited: (See LIC 809D). The following Type A and B deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.


An exit interview was conducted, and the report was reviewed with the licensee, Blanca Fernandez.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC809 (FAS) - (06/04)
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