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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312394
Report Date: 10/03/2024
Date Signed: 10/03/2024 12:24:35 PM

Document Has Been Signed on 10/03/2024 12:24 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:HERNANDEZ, ASCBETH ESPERANZAFACILITY NUMBER:
304312394
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, ASCBETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 415-9125
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
10/03/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Assistant, Argentina VelasquezTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 10/03/24 Licensing Program Analyst (LPA) Sun conducted an unannounced Case Management visit to ensure that the facility is staying within compliance of Title 22 regulations.

LPA called facility cell number to get access to enter facility gate. Licensee’s husband, Roberto Arevalo opened facility gate and walked LPA to Childcare room. Licensee’s husband stated licensee was not at facility because she inexpertly had to go to hospital in the evening of 10/1 and was kept at hospital for an un-scheduled surgery. LPA took census, there was 1 infant, and 2 preschool age children with 1 assistant (Jessica Delgado) in the childcare area. Assistant was changing infant’s diaper and the 2 preschool children were playing with puzzles. 30 minutes later, Assistant Argentina Velasquez arrived at the facility. The facility was operating within its licensed capacity and within compliance of staff-to-child ratios.

An on-site Facility Personnel Report Summary review showed that all facility residents, staff, or other individuals who require background checks have received criminal record and child abuse index clearances or exemptions.

LPA interviewed licensee (S1) about their daily schedule with the children in care and staff and ratio. S1 stated they currently have about 10 children attending daily. Children eat, nap, and play in the childcare areas. S1 stated they currently have 2 assistants, Staff #2 (S2) works Monday to Friday. S1 stated not aware if facility providing overnight care at this time, that last child leaves the childcare by 8:00pm. S1 stated currently they are providing transportation for older children only if parents call and request transportation. S1 stated S1 and S2 are supervising the children in care.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HERNANDEZ, ASCBETH ESPERANZA
FACILITY NUMBER: 304312394
VISIT DATE: 10/03/2024
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Assistant was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The LPA conducted an exit interview and reviewed the report with the Assistant, Argentina Velasquez. The “Notice of Site Visit” was posted, and the licensee is aware that it shall remain posted for 30 days. The Appeal Rights were explained. The licensee received a copy of the Appeal Rights (LIC 9058 01/16), their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First-level appeals should be sent to the Regional Manager to the address listed above.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
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