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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409522
Report Date: 08/08/2024
Date Signed: 08/08/2024 10:37:49 AM

Document Has Been Signed on 08/08/2024 10:37 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, 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: 4DATE:
08/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Karla Urquillo AlfaroTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On August 8, 2024 at 9:30am Licensing Program Analyst (LPA) Indira Loza arrived at the Licensee's home for the purpose of delivering an amended report and conducting a Plan of Correction (POC) visit. Present during the visit were one school-age, one (1) preschool-age child, one (1) infant, and the Licensee's minor child. The Licensee was not present during at the home, the Licensee's fingerprint cleared assistant, Karla Urquillo Alfaro, was caring for the children. LPA toured the home for a health and safety check.

On July 23, 2024 one Type A citation was issued for operating over capacity. The facility was operating within the license capacity during today's visit. Therefore the citation will be cleared.

Exit interview conducted.
Report and Appeal Rights provided to Assistant Karla Urquillo Alfaro.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
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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