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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566211693
Report Date: 03/06/2024
Date Signed: 03/06/2024 02:09:07 PM

Document Has Been Signed on 03/06/2024 02:09 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
566211693
ADMINISTRATOR:MAXIMA HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 796-1133
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
03/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Maxima Hernandez TIME COMPLETED:
03:00 PM
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On March 6, 2024 at 1:00PM, Licensing Program Analysts (LPAs) Laura Villanueva and Aaliyah Zendejas made an unannounced visit to conduct a Case Management-Deficiencies Inspection. LPAs met with licensee, Maxima Hernandez and explained the purpose of the inspection. LPAs and licensee toured the interior and exterior of the home. Licensee and assistant was caring for 10 children at the time of the inspection.

LPA's observed a working fountain. LPAs discussed regulations for bodies of water. Licensee asked husband to remove water in LPAs presence. LPAs reviewed citations given on 02/08/2024, and generated a letter of deficiency citations cleared.

No deficiencies cited. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed in Spanish with the licensee, Maxima Hernandez.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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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