<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409522
Report Date: 07/23/2024
Date Signed: 07/23/2024 01:53:33 PM

Document Has Been Signed on 07/23/2024 01:53 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:HERNANDEZ, GLADYSFACILITY NUMBER:
073409522
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 10DATE:
07/23/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Gladys HernandezTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On July 23, 2024 at 9:11am Licensing Program Analyst (LPA) Indira Loza met with Licensee Gladys Hernandez. Present during the visit were four (4) school-age children, four (4) preschoolers, and two (2) infants, and the Licensee's child (over 10 years old). The Licensee left shortly after with four (4) school-age children. LPA toured the home for a health and safety check.

The amount of children present in the home violates California Code of Regulation 102416.5 which is a Type A violation.

LPA informed Licensee Hernandez that this report dated 07/23/24 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the safety of children in care. LPA also informed the Licensee to provide a copy of this licensing report, dated 07/23/24 documenting a Type A citation, to parents/guardians of all children currently enrolled by the next business day, or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or another written statement, must be placed in the child's file for verification.

See LIC809-D for the Type A deficiency.

Exit interview conducted.
Report and Appeal Rights provided to Licensee Gladys Hernandez.
Notice of Site visit must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 07/23/2024 01:53 PM - It Cannot Be Edited


Created By: Indira Loza On 07/23/2024 at 01:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: HERNANDEZ, GLADYS
FACILITY NUMBER: 073409522

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/24/2024
Section Cited
CCR
102416.5(a)

1
2
3
4
5
6
7
Staffing Ratio and Capacity: (a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This regulation was not as evidenced by:
1
2
3
4
5
6
7
The Licensee shall review the regulations for Capacity and send the LPA a plan detailing how they plan to keep the daycare running in capacity. This shall be sent to the LPA no later than July 23, 2024.
8
9
10
11
12
13
14
Based on observation and records reviewed, it was determined that the License has a maximum capacity of 8 children, and the Licensee had 10 children in care, which poses an immediate risk to the Health, safety, and personal rights of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 07/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/23/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2