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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020244
Report Date: 05/16/2023
Date Signed: 05/16/2023 03:23:57 PM

Document Has Been Signed on 05/16/2023 03:23 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:FERNANDO FAMILY CHILD CAREFACILITY NUMBER:
198020244
ADMINISTRATOR:SHAMILA & TERVINE FERNANDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 728-7251
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 10DATE:
05/16/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Licensees Trevine Fernando and Shamila Fernando TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced case management visit on 5/16/23. LPA met with Licensees Trevine Fernando and Shamila Fernando. LPA observed 10 children napping upon arrival. LPA informed Licensees the purpose of this visit is to follow up on the unusual incident report received on 5/10/23.

During the inspection, LPA interviewed licensees regarding unusual incident.
Due to insufficient information available at this time, LPA will return for subsequent visit.
No deficiencies will be cited today.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Trevine Fernando

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023
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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