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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310373
Report Date: 10/10/2025
Date Signed: 10/10/2025 10:10:18 AM

Document Has Been Signed on 10/10/2025 10:10 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:RAMIREZ DE HERNANDEZ,YADHIRAFACILITY NUMBER:
304310373
ADMINISTRATOR/
DIRECTOR:		RAMIREZDEHERNANDEZ,YADHIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 791-1114
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
10/10/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Assistant, Dora CancheTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 10/10/2025, Licensing Program Analysts (LPA) Cynthia Sun conducted a Case Management – Legal/Noncompliance inspection assisted by Assistant, Dora Leticia Rodriguez Canche to review compliance with the Stipulation and Waiver; And Order CDSS No. 6624107101 (Stipulation) adopted by the Department on 27 February 2025. Licensee spoke to LPA, licensee was at hospital during visit. Census at the time of the visit was 4 infant children. The facility was operating within ratios and capacity. Facility hours are 7:00 AM to 6:00 PM, Monday through Friday. An on-site Facility Personnel Report Summary review showed that all facility staff or other individuals who require background checks have received criminal record and child abuse index clearances or exemptions.

The following items in the Stipulation were reviewed for compliance during the inspection.

The licensee shall maintain current personnel records as required by Regulation section 102416.1 and ensure that all employees have current pediatric CPR- and first aid training on file. Personnel records were reviewed for three assistants present. Valid pediatric CPR and first aid certificate, a valid mandated reporter, and immunization's were in file.

The Stipulation shall be posted in a conspicuous place at the licensed home for the duration of the probationary period. The LPA observed the Stipulation was posted at the entrance of the licensed facility.

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NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Cynthia Sun
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: RAMIREZ DE HERNANDEZ,YADHIRA
FACILITY NUMBER: 304310373
VISIT DATE: 10/10/2025
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LPA was unable to confirm if the licensee attended an in person and completed the Family Child Care Home Orientation within six months of the adoption of Stipulation. LPA was unable to verify completion of class because licensee was in court during inspection visit. LPA will request completion of form by email from licensee.

The licensee shall conduct quarterly training with staff regarding Care and Supervision according to Regulation section 102417(a). The licensee was reminded that the first quarterly training should be completed by May 27, 2025. The licensee was advised that documentation of the training should be available for review by the Department. LPA will request training forms by email from licensee.

The assistant was reminded that she report to the Department any unusual incident as required by Regulation section 102416.2, including child death or injury that requires medical treatment, suspected physical, sexual, or verbal abuse of any child, physical plant changes, and unexplained absences of children in care.

The LPA observed a roster which the licensee stated was current. During the inspection, the LPA observed that children were separated and supervised by age group. During visit the four infants presents were all together playing in the same space area. The licensee placed a physical boundary separating the groups. A staff member was assigned to supervise one group specifically. The LPA observed that the primary focus of staff was the direct supervision of children.

The licensee shall be physically present in the licensed home premises for at least 80% of the facility’s operating hours. The licensee must inform the Department before absence from the licensed home, including start and end dates, names of the assistants present during the licensee’s absence, and the number of children in attendance during the licensee’s absence.

The facility was in compliance. No violations of Title 22 or the Stipulation were observed during today’s inspection. An exit interview was conducted with Assistant, Dora Canche. Appeal Rights and a copy of this licensing report were provided and a signatures on this report acknowledge receipt of these forms.

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END OF REPORT

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Cynthia Sun
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
LIC809 (FAS) - (06/04)
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