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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566211693
Report Date: 05/24/2024
Date Signed: 05/24/2024 11:20:31 AM

Document Has Been Signed on 05/24/2024 11:20 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
566211693
ADMINISTRATOR/
DIRECTOR:		MAXIMA HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 796-1133
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
05/24/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Maxima HernandezTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On May 24 2024 at 9:25 AM, Licensing Program Manager (LPM), George Mingle and Licensing Program Analysts (LPAs), Laura Villanueva, David Roman, and Elizabeth George met with Licensee, Maxima Hernandez for an office meeting held at the Santa Barbara Regional Office.

Concerns regarding the following Title 22, Division 12 sections were reviewed with Licensee and copies were provided.
  • 102417 Operation of a Family Child Care Home
  • 102425 Infant Safe Sleep
  • 102417.5 Bodies of water
  • 102416.5 Staffing ratio and Capacity
  • 102421 Child’s Records
  • 102416.1 Personnel Records
  • 102370 Criminal Records Clearance
  • 102395 Penalties
  • 102416.2 Reporting Requirements

In response to the discussion, licensee has agreed to the following:
  • Licensee will attend an in-person/virtual family child care orientation at the earliest convenience discussed with LPA.
  • Licensee shall submit a written statement indicating how she will maintain compliance with California Code of Regulations, Title 22, Division 12 at all times by 06/24/2024.

CONTINUED ON LIC809C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2024
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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 566211693
VISIT DATE: 05/24/2024
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  • Licensee will be placed on required inspections for next 2 years.
  • Licensee will operate in compliance Title 22, Division 12 Child Care Regulations at all times.

In addition to the above regulations, LPM Mingle reviewed and provided the following resources to licensee during this meeting:
  • PIN 20-24-CCP Recently Approved Safe Sleep Regulations in Effect
  • Safe Sleep – Frequently Asked Questions
  • LIC 9227 Individual Infant Sleeping Plan
  • Sample of 15 minute infant sleep tracking log


Licensee will review the following training on the Department's website https://ccld.childcarevideos.org/family-child-care-providers/ ) and provide a statement of her understanding of the training to the LPA by 6/24/2024:
- Record keeping in family child care
-Child care reporting
-Civil penalty
-Bodies of water
--How many children can attend a family child care home

LPA will send video links for training.

Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents/guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee is to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC809.

THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.

An exit interview was conducted with licensee, Maxima Hernandez. A copy of this report and appeal rights given
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC809 (FAS) - (06/04)
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