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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701116
Report Date: 06/04/2024
Date Signed: 06/04/2024 10:01:20 AM

Document Has Been Signed on 06/04/2024 10:01 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HERNANDEZ, DEBORAHFACILITY NUMBER:
015701116
ADMINISTRATOR/
DIRECTOR:		DEBORAH HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 535-9811
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/04/2024
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:46 AM
MET WITH:Deborah HernandezTIME VISIT/
INSPECTION COMPLETED:
12:03 PM
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Licensing Program Analyst Sidney Cortez, conducted a Change of Location and Increase Capacity Inspection for the facility belonging to Deborah Hernandez. The Fire Clearance was issued by the Hayward Fire Department on May 23, 2024.

Present for this visit was the licensee Deborah Hernandez. The home was toured to conduct a Health and Safety Inspection. The facility plans to operate from 7:00AM until 6PM, Monday-Friday. This is a one story house which consists of a living room/dining room, 2 bathrooms,4 bedrooms,kitchen, and backyard. The home is neat and clean, with screened wall heaters. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during today's inspection.


On-limit-areas include: Living room/dining room, nap room (1 bedroom), and backyard
Isolation Area: will be in the nap room away from children in care.
The Off-Limit areas include: the kitchen, 3 bedrooms, and garage –which will be inaccessible by child safety gates, and visual supervision.

There are ample age appropriate toys, learning materials, and equipment that appear to be safe and in good condition. The home has a working smoke detector, carbon monoxide detector, working telephone, and First Aid Kit. The on limit patio is fenced and free from defects or dangerous conditions.
The home has a fully charged (3A40BC) fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone.
The licensee CPR and First Aid certificate is current and expires (June 2025). The licensee's mandated reporter training is complete and she received a certification of completion on
June 2025. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on MAY 2024.

2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
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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