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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010444
Report Date: 02/11/2025
Date Signed: 02/11/2025 10:01:52 AM

Document Has Been Signed on 02/11/2025 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:HERNANDEZ, NORMA FCCHFACILITY NUMBER:
173010444
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
02/11/2025
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Norma HernandezTIME VISIT/
INSPECTION COMPLETED:
10:10 AM
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On 02/11/2025, Licensing Program Analyst, Sebastian Phouthavong has conducted Case Management Visit regarding Licensee requesting for an increase of capacity to the daycare. Today, LPA met with Licensee, Norma Hernandez. Prior to visit, Licensee received a Fire Safely Inspection conducted by the local fire department and LPA received an approved STD 850 for an increase of capacity to 14 daycare children on 02/06/2025.

During the inspection the home was toured inside and outside. The licensee was supervising 4 children and operating within the licensed capacity and ratio requirements. The facility’s regular operating hours are Monday - Friday, 6:30 AM - 5:00 PM, but in addition is on call for anytime. The floor plan submitted by the licensee was reviewed and verified. Licensee was reminded that an assistant must be present when the capacity is over 8 daycare children. Also that the children shall be supervised a staff member with a current Pediatric CPR and First Aid Certification issued by American Red Cross or the American Heart Association, or by approved Emergency Medical Services Authority (EMSA) vendor. Licensee has met the requirements to increase her capacity and has been approved.

Additionally, Licensee requested to make three bedroom and one additional bathroom on limits. LPA observed the areas which have met Community Care Licensing Requirements. The area has been approved for daycare.

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.

Exit interview conducted and report was reviewed with the Licensee, Norma Hernandez.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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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