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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243910980
Report Date: 04/20/2021
Date Signed: 04/20/2021 11:52:14 AM

Document Has Been Signed on 04/20/2021 11:52 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:HERNANDEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
243910980
ADMINISTRATOR:HERNANDEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 588-0174
CITY:SANTA NELLASTATE: CAZIP CODE:
95322
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/20/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria HernandezTIME COMPLETED:
12:30 PM
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On 4/20/21 Licensing Program Analysts (LPAs) Caroline Harris and Roman Iglesias conducted a Plan of Correction inspection. LPAs met with licensee, Maria Hernandez and toured the home inside and outside. A census was taken.

The purpose of the inspection is to clear deficiencies that were previously cited on 4/13/21. LPAs observed the home to be cleaned and picked up and free from clothing and trash on the ground and through out the home. LPA's also observed keep out of reach items to be placed away and out of reach from children. The back yard was also free from cat feces and sharp objects.

During today’s inspection, LPAs provided a Letter of Deficiency Citations Cleared. An exit interview was conducted with Maria Hernandez. Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, no deficiencies were cited during today’s inspection.

A copy of this report and LIC 9213 Notice of Site Inspection were provided to the licensee, Maria Hernandez. This report shall be made available to the public upon request. LIC 9213 Notice of Site Inspection is required to be posted for 30 days.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2021
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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