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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629654
Report Date: 06/21/2023
Date Signed: 06/21/2023 09:55:10 AM

Document Has Been Signed on 06/21/2023 09:55 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HERNANDEZ, EUNICE FAMILY CHILD CAREFACILITY NUMBER:
376629654
ADMINISTRATOR:EUNICE HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 602-9967
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/21/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Eunice Hernandez, ProviderTIME COMPLETED:
10:00 AM
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On 06/21/2023 at 8:30 am, Licensing Program Analyst (LPA) Diana Sanchez conducted an announced Pre-licensing inspection with provider, Eunice Hernandez. The purpose of the inspection is to check the pool gate and ensure it meets regulations standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes.

LPA and provider Eunice checked the pool fence. The pool has a five feet tall see thru mesh fence secured on both ends to the outside white fence. The pool door swing away from the pool and it self closes with a self-latching device. It is to be noted that the pool has been properly secured according to regulation requirements.

During inspection provider had questions regarding the request for authorization to dispense medication according to the Incidental Medical Services (IMS). LPA explained in detail the requirements to the provider.

LPA explained the capacity limitations to provider. The maximum number of children for whom care shall be provided when there is an assistant provider in the home, including children under age 10 who live in the licensee's home and the assistant provider's children under age 10, shall be either: Twelve (12) children with no more than four of whom may be infants or Fourteen (14) children, at least two of the children are at least six years of age and no more than three infants with landlord consent.
Facility is currently in substantial compliance; all requirements for a large license have been met. A large license for a maximum capacity of 14 children will be granted effective today 06/21/2023.

LPA Sanchez explained inspection report to Eunice Hernandez. Provider stated she understood. Exit interview conducted and report was reviewed with the Provider, Eunice Hernandez.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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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