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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173007363
Report Date: 01/19/2024
Date Signed: 01/19/2024 02:27:07 PM

Document Has Been Signed on 01/19/2024 02:27 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:HERNANDEZ, HERLINDA FCCHFACILITY NUMBER:
173007363
ADMINISTRATOR:HERNANDEZ, HERLINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 530-9141
CITY:FINLEYSTATE: CAZIP CODE:
95435
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
01/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Herlinda HernandezTIME COMPLETED:
02:45 PM
NARRATIVE
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A Case Management visit in conjunction with a complaint visit was conducted by Licensing Program Analysts (LPAs) Cindy Castro and Glenn Ouye who met with licensee Herlinda Hernandez in response to children’s corroborating statements indicating that the licensee screams and yells when children are not listening, that this hurts their ears and makes them feel unsafe, and that Staff 1 (S1) will also yell.

California Code of Regulations, Title 22 is cited on the attached LIC 9099-D. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. An exit interview was conducted, and this report was read and discussed with Herlinda Hernandez. Appeal rights were provided.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Cindy Castro
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2024
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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Document Has Been Signed on 01/19/2024 02:27 PM - It Cannot Be Edited


Created By: Cindy Castro On 01/19/2024 at 01:27 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HERNANDEZ, HERLINDA FCCH
FACILITY NUMBER: 173007363

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/19/2024
Section Cited
CCR
102423(a)(1)

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Each child receiving services from a family child care home shall have certain rights that shall not be waived… To be treated with dignity in his/her personal relationship with staff and other persons. This requirement is not met as evidenced by: interviews conducted on
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Licensee and S1 will schedule a date and attend a training about a Personal Rights topic with local Resource and Referral Agency by 02/19/24 and provide proof to the Department once training is complete. Licensee and S1 will also review handout provided: Tell Me What to Do Instead handout about appropriate
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10/02/23 indicating that licensee and S1 yell when children are not listening, hurting children’s ears and making them feel unsafe. This poses a potential health and safety risk to the children in care.
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communication with children.
Licensee stated that she would submit proof of completed training to the department via mail, email, or fax. Email: cindy.castro@dss.ca.gov Fax: 707-588-5099

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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:Alexis Hollon
LICENSING EVALUATOR NAME:Cindy Castro
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2024


LIC809 (FAS) - (06/04)
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